Individual
MARK MULLENBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1175 MOUNT HOOD AVENUE, WOODBURN, OR 97071
(503) 982-2000
(503) 982-0660
Mailing address
PO BOX 190, TOPPENISH, WA 98948-0190
(509) 865-6175
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7489
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
269051
—
OR
Enumeration date
10/12/2006
Last updated
07/08/2007
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