Provider Demographics
NPI:1588793970
Name:MUELLER, GORDON DWIGHT (DDS)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:DWIGHT
Last Name:MUELLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17706 HUNTMASTER CT
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:MD
Mailing Address - Zip Code:21797-7934
Mailing Address - Country:US
Mailing Address - Phone:410-489-9577
Mailing Address - Fax:
Practice Address - Street 1:833 ROCKVILLE PIKE STE G
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1271
Practice Address - Country:US
Practice Address - Phone:301-468-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD97301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice