Provider Demographics
NPI:1689966376
Name:MULLICA, CARRIE ANN-GILBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:ANN-GILBERT
Last Name:MULLICA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CROCKER BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2547
Mailing Address - Country:US
Mailing Address - Phone:586-469-6336
Mailing Address - Fax:586-469-1535
Practice Address - Street 1:312 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2547
Practice Address - Country:US
Practice Address - Phone:586-469-6336
Practice Address - Fax:586-469-1535
Is Sole Proprietor?:No
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist