Provider Demographics
NPI:1508900556
Name:MUCKLOW, WILLIAM BRERETON (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRERETON
Last Name:MUCKLOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 WALLINGFORD AVE
Mailing Address - Street 2:APT. E8
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6160
Mailing Address - Country:US
Mailing Address - Phone:610-565-2151
Mailing Address - Fax:610-565-1101
Practice Address - Street 1:1245 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1210
Practice Address - Country:US
Practice Address - Phone:610-565-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS 0209391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry