1093713398 NPI number — DR. DAMIEN A MULVANY DMD

Table of content: DR. DAMIEN A MULVANY DMD (NPI 1093713398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093713398 NPI number — DR. DAMIEN A MULVANY DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULVANY
Provider First Name:
DAMIEN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093713398
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/16/2006
NPI Reactivation Date:
03/22/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3627 S PENNSYLVANIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80113-3753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-781-0624
Provider Business Mailing Address Fax Number:
303-781-9551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3627 S PENNSYLVANIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113-3753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-781-0624
Provider Business Practice Location Address Fax Number:
303-781-9551
Provider Enumeration Date:
07/11/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  105094 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)