Organization Active NPI

Sydney Ann Mullins Dma

  • Dentist
  • Louisville, KY
National Provider Identifier
1053462622
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
SYDNEY ANN MULLINS DMA
Practice address
1313 Lyndon Lane
Ste 211
Louisville, KY 40222
Phone
(502) 412-1166
Fax
(502) 339-0433
NPI assigned
Jan 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Sydney Ann Mullins, DMDNPI 1932198199
Title
Owner
Phone
(502) 412-1166

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1313 Lyndon Lane
Ste 211
Louisville, KY 40222

Mailing address

1313 Lyndon Lane
Ste 211
Louisville, KY 40222
Phone (502) 412-1166

Other identifiers 2

IdentifierTypeStateIssuer
60073236MedicaidKY
4500353000OtherKYEPSDT

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053462622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 LYNDON LANE",
            "address_2": "STE 211",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40222",
            "telephone_number": "502-412-1166",
            "fax_number": "502-339-0433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 LYNDON LANE",
            "address_2": "STE 211",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40222",
            "telephone_number": "502-412-1166",
            "fax_number": "502-339-0433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYDNEY ANN MULLINS DMA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MULLINS",
        "authorized_official_first_name": "SYDNEY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-412-1166",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60073236",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EPSDT",
            "identifier": "4500353000",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.