Provider Demographics
NPI:1093027971
Name:MUEHLEISEN, EUGENE FRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:FRED
Last Name:MUEHLEISEN
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 1:6386 ALVARADO COURT - SUITE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4906
Mailing Address - Country:US
Mailing Address - Phone:619-287-5000
Mailing Address - Fax:619-287-4627
Practice Address - Street 1:6386 ALVARADO COURT - SUITE 110
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-4906
Practice Address - Country:US
Practice Address - Phone:619-287-5000
Practice Address - Fax:619-287-4627
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33218122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist