Provider Demographics
NPI:1073658761
Name:MUELLER, ELIZABETH STOCKLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:STOCKLEY
Last Name:MUELLER
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 1:8364 OAKDALE CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-5009
Mailing Address - Country:US
Mailing Address - Phone:513-234-9188
Mailing Address - Fax:
Practice Address - Street 1:9200 MONTGOMERY RD
Practice Address - Street 2:SUITE 4B
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-7789
Practice Address - Country:US
Practice Address - Phone:513-791-3660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0172601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0520056Medicaid
OH017260OtherOHIO BOARD LICENSE