Active NPI
Patrick Joseph Mullally, DDS, MSD
- Dentist
- Muskegon, MI
National Provider Identifier
1902011208
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901019169
- Practice address
- 513 Seminole Rd
Muskegon, MI 49444-3719 - Phone
- (231) 733-9676
- Fax
- (231) 733-0868
- NPI assigned
- May 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901019169 | MI | Primary |
Addresses
Primary practice location
513 Seminole Rd
Muskegon, MI 49444-3719
Mailing address
2160 Geneva Lane
Muskegon, MI 49441
Phone (231) 780-2716
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901019169 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178841600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208390400000",
"number": "1902011208",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2160 GENEVA LANE",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "49441",
"telephone_number": "231-780-2716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "513 SEMINOLE RD",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494443719",
"telephone_number": "231-733-9676",
"fax_number": "231-733-0868"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLALLY",
"first_name": "PATRICK",
"middle_name": "JOSEPH",
"name_prefix": "Dr.",
"credential": "DDS, MSD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-11",
"last_updated": "2008-04-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901019169",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Muskegon, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.