Provider Demographics
NPI:1710152749
Name:VICTORIA DENTAL ASSOICATES
Entity Type:Organization
Organization Name:VICTORIA DENTAL ASSOICATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-575-8088
Mailing Address - Street 1:304 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1742
Mailing Address - Country:US
Mailing Address - Phone:361-575-8088
Mailing Address - Fax:361-575-1553
Practice Address - Street 1:304 SALEM RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1742
Practice Address - Country:US
Practice Address - Phone:361-575-8088
Practice Address - Fax:361-575-1553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. GARY W. MUELLER DBA VICTORIA DENTAL ASSOICATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty