Provider Demographics
NPI:1235861600
Name:PHIL MULDER DDS
Entity Type:Organization
Organization Name:PHIL MULDER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MULDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-722-2279
Mailing Address - Street 1:1173 PECK ST
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3190
Mailing Address - Country:US
Mailing Address - Phone:231-722-2279
Mailing Address - Fax:231-722-2235
Practice Address - Street 1:1173 PECK ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-3190
Practice Address - Country:US
Practice Address - Phone:231-722-2279
Practice Address - Fax:231-722-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental