Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4135 | KY |
NPI | 1003024316 |
---|---|
Provider Name | Dr. Richard Keith Mullins |
First Address | Florence, KY 41042-2176 |
Second Address | Florence, KY 41042-2176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2007 |
Last Update Date | 08/07/2007 |