Provider Demographics
NPI:1144462045
Name:MULLINS, TONY LEWIS (DDS)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:LEWIS
Last Name:MULLINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 TALL OAKS CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025-2334
Mailing Address - Country:US
Mailing Address - Phone:405-471-1380
Mailing Address - Fax:405-359-5094
Practice Address - Street 1:1729 ANALOG DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-1944
Practice Address - Country:US
Practice Address - Phone:972-437-0200
Practice Address - Fax:972-437-0035
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice