Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | 00004920 | WA |
NPI | 1003411562 |
---|---|
Provider Name | Dorthe H Mullins |
First Address | Mercer Island, WA 98040-0128 |
Second Address | Mercer Island, WA 98040-4053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2020 |
Last Update Date | 02/12/2020 |