Provider Demographics
NPI:1639357510
Name:MICHAEL P. MUCKLER, DDS, PA
Entity Type:Organization
Organization Name:MICHAEL P. MUCKLER, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:704-489-9100
Mailing Address - Street 1:2226 N HIGHWAY 16
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8254
Mailing Address - Country:US
Mailing Address - Phone:704-489-9100
Mailing Address - Fax:
Practice Address - Street 1:2226 N HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8254
Practice Address - Country:US
Practice Address - Phone:704-489-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:6523
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223G0001X122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty