Provider Demographics
NPI:1073783973
Name:JAY P. MUELLER D.D.S.
Entity Type:Organization
Organization Name:JAY P. MUELLER D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-529-1999
Mailing Address - Street 1:57 E HATTENDORF AVE
Mailing Address - Street 2:SUITE # 150
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-1501
Mailing Address - Country:US
Mailing Address - Phone:630-529-1999
Mailing Address - Fax:630-529-1960
Practice Address - Street 1:57 E HATTENDORF AVE
Practice Address - Street 2:SUITE # 150
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-1501
Practice Address - Country:US
Practice Address - Phone:630-529-1999
Practice Address - Fax:630-529-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-017-651122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty