Provider Demographics
NPI:1952141228
Name:MULLENEAUX, WESLEY (DMD)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:
Last Name:MULLENEAUX
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:SAINT DAVID
Mailing Address - State:AZ
Mailing Address - Zip Code:85630-0050
Mailing Address - Country:US
Mailing Address - Phone:520-965-8662
Mailing Address - Fax:
Practice Address - Street 1:2901 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-4706
Practice Address - Country:US
Practice Address - Phone:520-357-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-25
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0121511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice