Provider Demographics
NPI:1992854202
Name:MULLINS, EDMUND EUGENE JR (DDS)
Entity Type:Individual
Prefix:
First Name:EDMUND
Middle Name:EUGENE
Last Name:MULLINS
Suffix:JR
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 1:6808 STONEMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2700
Mailing Address - Country:US
Mailing Address - Phone:804-266-4989
Mailing Address - Fax:804-262-5071
Practice Address - Street 1:6808 STONEMAN ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2700
Practice Address - Country:US
Practice Address - Phone:804-266-4989
Practice Address - Fax:804-262-5071
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004130122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist