Provider Demographics
NPI:1699268912
Name:MUECKAY, LI Z (DDS)
Entity type:Individual
Prefix:
First Name:LI
Middle Name:Z
Last Name:MUECKAY
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 1:1381 S. PATRICK DRIVE
Mailing Address - Street 2:45TH MEDICAL GROUP, DENTAL CLINIC
Mailing Address - City:PATRICK AIR FORCE BASE
Mailing Address - State:FL
Mailing Address - Zip Code:32925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1381 S. PATRICK DR
Practice Address - Street 2:45TH MEDICAL GROUP CLINIC, DENTAL CLINIC
Practice Address - City:PATRICK AIR FORCE BASE
Practice Address - State:FL
Practice Address - Zip Code:32925
Practice Address - Country:US
Practice Address - Phone:850-797-7733
Practice Address - Fax:321-494-6366
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00203609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist