John Gordon Mullally, DDS

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

12805 Issued in MD

Practice address

1407 York Rd Ste 210
Lutherville, MD 21093-6042

Phone

(410) 821-5553

Fax

(410) 825-7213

NPI assigned

Mar 27, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549324800000",
    "number": "1164541892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 YORK RD STE 210",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210936042",
            "telephone_number": "410-821-5553",
            "fax_number": "410-825-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 YORK RD STE 210",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210936042",
            "telephone_number": "410-821-5553",
            "fax_number": "410-825-7213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLALLY",
        "first_name": "JOHN",
        "middle_name": "GORDON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2019-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MD",
            "license": "12805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Virginia Anne Moratz, OTR
• Raven A Morris
• Jennifer Elizabeth Mosier, OTR
• Ms-HC, LLC
• Lynda G Mules, PTA
• Lisa A Mullen, M.D.
• Laura M Mumford, M.D.
• Janice Leigh Murach, O.T.
• Michael S. Murphy, M.D.
• Penelope Anne Murphy, RPH

• Endodontics in Lutherville, MD
• Providers in Lutherville, MD by specialty
• Endodontics in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.