Provider Demographics
NPI:1164641718
Name:KELLY MUELLER, CAROLYN (DMD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:KELLY MUELLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CAROLYN
Other - Middle Name:ELISE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:318 HUNTER PATH RD
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-2715
Mailing Address - Country:US
Mailing Address - Phone:717-566-2055
Mailing Address - Fax:
Practice Address - Street 1:318 HUNTER PATH RD
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-2715
Practice Address - Country:US
Practice Address - Phone:717-566-2055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026298L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice