Mark Mullenbach, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7489 Issued in OR

Practice address

1175 Mount Hood Avenue
Woodburn, OR 97071

Phone

(503) 982-2000

Fax

(503) 982-0660

NPI assigned

Oct 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

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

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437248804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989480190",
            "telephone_number": "509-865-6175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 MOUNT HOOD AVENUE",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "97071",
            "telephone_number": "503-982-2000",
            "fax_number": "503-982-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLENBACH",
        "first_name": "MARK",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "269051",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karina Morales-Ornelas
• Angeles Santos Morales
• Lloyd Tetsuo Morita, MD
• Megan Elizabeth Morse, RN
• Sina Mousavi
• Patra J Murdock, NP
• Janet A Murphy, SPEEH THERAPIST
• National Vision, Inc.
• Emilee Nehring
• Scott Leonard Nehring, O.D.

• General Practice Dentistry in Woodburn, OR
• Providers in Woodburn, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.