Provider Demographics
NPI:1902087158
Name:MULLINS, JOANNA MARIE (RDH , BS)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:MARIE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:RDH , BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 SE HUDSON CT
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-2314
Mailing Address - Country:US
Mailing Address - Phone:503-492-3217
Mailing Address - Fax:
Practice Address - Street 1:13255 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1548
Practice Address - Country:US
Practice Address - Phone:503-255-1901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3966124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist