Provider Demographics
NPI:1790873032
Name:MULLENAUX, DANIEL LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LYNN
Last Name:MULLENAUX
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21805 S ELLSWORTH RD STE 110
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-9365
Mailing Address - Country:US
Mailing Address - Phone:480-313-5889
Mailing Address - Fax:
Practice Address - Street 1:21805 S ELLSWORTH RD STE 110
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-9365
Practice Address - Country:US
Practice Address - Phone:480-882-1151
Practice Address - Fax:480-655-5248
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist