Provider Demographics
NPI:1316342041
Name:MUELLER DENTAL ASSOCIATES PC
Entity type:Organization
Organization Name:MUELLER DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:W
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-448-0333
Mailing Address - Street 1:11104 S NATOMA AVE
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-1930
Mailing Address - Country:US
Mailing Address - Phone:708-448-0333
Mailing Address - Fax:
Practice Address - Street 1:11104 S NATOMA AVE
Practice Address - Street 2:
Practice Address - City:WORTH
Practice Address - State:IL
Practice Address - Zip Code:60482-1930
Practice Address - Country:US
Practice Address - Phone:708-448-0333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUELLER DENTAL ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190289431223X0400X
IL019018192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty