Provider Demographics
NPI:1952909707
Name:MCMULLEN, CRAIG (DDS, MS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10192 GRAND RIVER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-6516
Mailing Address - Country:US
Mailing Address - Phone:810-220-1700
Mailing Address - Fax:
Practice Address - Street 1:10192 GRAND RIVER RD STE 101
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6516
Practice Address - Country:US
Practice Address - Phone:810-220-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2021-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010223121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty