Provider Demographics
NPI:1427113315
Name:MUCKLER, MICHAEL PAUL (DDS, PA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PAUL
Last Name:MUCKLER
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19620 KUYKENDAHL RD
Mailing Address - Street 2:SUITE #210
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3400
Mailing Address - Country:US
Mailing Address - Phone:832-970-4995
Mailing Address - Fax:832-442-5240
Practice Address - Street 1:19620 KUYKENDAHL RD
Practice Address - Street 2:SUITE #210
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3400
Practice Address - Country:US
Practice Address - Phone:832-970-4995
Practice Address - Fax:832-442-5240
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX277771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6523OtherSTATE LICENSE NUMBER