Provider Demographics
NPI:1649382359
Name:MUELLER, MARY ALICE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ALICE
Last Name:MUELLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61362-1503
Mailing Address - Country:US
Mailing Address - Phone:815-663-0402
Mailing Address - Fax:
Practice Address - Street 1:360 1ST ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-2356
Practice Address - Country:US
Practice Address - Phone:815-223-9057
Practice Address - Fax:815-223-9248
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice