Provider Demographics
NPI:1891356416
Name:MULLANY, DAVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVIS
Middle Name:
Last Name:MULLANY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TREMONT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02364-1256
Mailing Address - Country:US
Mailing Address - Phone:413-429-6602
Mailing Address - Fax:
Practice Address - Street 1:10 ENTERPRISE ST STE 7
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-3315
Practice Address - Country:US
Practice Address - Phone:781-934-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18583621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice