Provider Demographics
NPI:1396630687
Name:MPDA MULLEN LLC
Entity type:Organization
Organization Name:MPDA MULLEN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:CREASMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-534-1289
Mailing Address - Street 1:805 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5282
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:102 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:MULLEN
Practice Address - State:NE
Practice Address - Zip Code:69152-5224
Practice Address - Country:US
Practice Address - Phone:308-534-1289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty