Provider Demographics
NPI:1972687416
Name:MULLY, ALAN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:R
Last Name:MULLY
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 1:149 CAVE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEVERETT
Mailing Address - State:MA
Mailing Address - Zip Code:01054-9728
Mailing Address - Country:US
Mailing Address - Phone:413-367-2817
Mailing Address - Fax:
Practice Address - Street 1:149 CAVE HILL RD
Practice Address - Street 2:
Practice Address - City:LEVERETT
Practice Address - State:MA
Practice Address - Zip Code:01054-9728
Practice Address - Country:US
Practice Address - Phone:413-367-2817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN14014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist