Provider Demographics
NPI:1407558018
Name:MUELLER, STACEY (BS, RDH)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:MUELLER
Suffix:
Gender:F
Credentials:BS, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15630 BOONES FERRY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3455
Mailing Address - Country:US
Mailing Address - Phone:971-346-0355
Mailing Address - Fax:833-262-1495
Practice Address - Street 1:15630 BOONES FERRY RD STE 6
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3455
Practice Address - Country:US
Practice Address - Phone:971-346-0355
Practice Address - Fax:833-262-1495
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4097124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist