Provider Demographics
NPI:1932198199
Name:MULLINS, SYDNEY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:ANN
Last Name:MULLINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 LYNDON LN
Mailing Address - Street 2:SUITE 211
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-7351
Mailing Address - Country:US
Mailing Address - Phone:502-412-1166
Mailing Address - Fax:502-339-0433
Practice Address - Street 1:1313 LYNDON LN
Practice Address - Street 2:SUITE 211
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-7351
Practice Address - Country:US
Practice Address - Phone:502-412-1166
Practice Address - Fax:502-339-0433
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7323122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60073236Medicaid
KY005171OtherPASSPORT/DORAL