Provider Demographics
NPI:1750791828
Name:MCMULLEN, RAYMOND (DDS)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:MCMULLEN
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 1:2547 PLAINFIELD NAPERVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8909
Mailing Address - Country:US
Mailing Address - Phone:630-420-4145
Mailing Address - Fax:630-420-7582
Practice Address - Street 1:2547 PLAINFIELD NAPERVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8909
Practice Address - Country:US
Practice Address - Phone:630-420-4145
Practice Address - Fax:630-420-7582
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190184631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics