Provider Demographics
NPI:1952953234
Name:MULUH, MESHACK AKUMBOM (DDS)
Entity Type:Individual
Prefix:
First Name:MESHACK
Middle Name:AKUMBOM
Last Name:MULUH
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 1:7539 RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-6539
Mailing Address - Country:US
Mailing Address - Phone:832-655-8040
Mailing Address - Fax:
Practice Address - Street 1:1811 HIGHWAY 287 N STE 160
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7571
Practice Address - Country:US
Practice Address - Phone:817-405-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11113122300000X
TX361101223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice