Provider Demographics
NPI:1255472254
Name:GLEN E. MUELLER D.M.D., P.C.
Entity Type:Organization
Organization Name:GLEN E. MUELLER D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-842-0060
Mailing Address - Street 1:13096 TESSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3442
Mailing Address - Country:US
Mailing Address - Phone:314-842-0060
Mailing Address - Fax:314-842-0067
Practice Address - Street 1:13096 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3442
Practice Address - Country:US
Practice Address - Phone:314-842-0060
Practice Address - Fax:314-842-0067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental