1689966376 NPI number — DR. CARRIE ANN-GILBERT MULLICA DDS

Table of content: DR. CARRIE ANN-GILBERT MULLICA DDS (NPI 1689966376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689966376 NPI number — DR. CARRIE ANN-GILBERT MULLICA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLICA
Provider First Name:
CARRIE
Provider Middle Name:
ANN-GILBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

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:
1689966376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 CROCKER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT CLEMENS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48043-2547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-469-6336
Provider Business Mailing Address Fax Number:
586-469-1535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 CROCKER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CLEMENS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48043-2547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-469-6336
Provider Business Practice Location Address Fax Number:
586-469-1535
Provider Enumeration Date:
05/12/2011

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: 122300000X , with the licence number:  2901018537 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com