Daniel Lynn Mullenaux, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

6562 Issued in AZ

Practice address

21805 S Ellsworth Rd Ste 110
Queen Creek, AZ 85142-9365

Phone

(480) 882-1151

Fax

(480) 655-5248

NPI assigned

Oct 11, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671408000000",
    "number": "1790873032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21805 S ELLSWORTH RD STE 110",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851429365",
            "telephone_number": "480-313-5889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21805 S ELLSWORTH RD STE 110",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851429365",
            "telephone_number": "480-882-1151",
            "fax_number": "480-655-5248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLENAUX",
        "first_name": "DANIEL",
        "middle_name": "LYNN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "6562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2022; 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.