Provider Demographics
NPI:1811160898
Name:MULLEN, KATHLEEN V (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:V
Last Name:MULLEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:118 DICKERSON RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-2538
Mailing Address - Country:US
Mailing Address - Phone:215-699-0650
Mailing Address - Fax:215-699-9599
Practice Address - Street 1:118 DICKERSON RD
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2538
Practice Address - Country:US
Practice Address - Phone:215-699-0650
Practice Address - Fax:215-699-9599
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS025133L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry