Provider Demographics
NPI:1508885682
Name:MUUL, MICHAEL ILLAR (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ILLAR
Last Name:MUUL
Suffix:
Gender:M
Credentials:DDS, PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6798 OAK HALL LN
Mailing Address - Street 2:SUITE A1
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4892
Mailing Address - Country:US
Mailing Address - Phone:410-290-7757
Mailing Address - Fax:410-290-8182
Practice Address - Street 1:6798 OAK HALL LN
Practice Address - Street 2:SUITE A1
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-4892
Practice Address - Country:US
Practice Address - Phone:410-290-7757
Practice Address - Fax:410-290-8182
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD108041223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD465RMedicare UPIN