Provider Demographics
NPI:1922410299
Name:MUELLER FAMILY DENTISTRY, P.C.
Entity Type:Organization
Organization Name:MUELLER FAMILY DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-212-1521
Mailing Address - Street 1:310 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52057-1742
Mailing Address - Country:US
Mailing Address - Phone:563-927-3612
Mailing Address - Fax:563-927-8711
Practice Address - Street 1:1610 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ROBINS
Practice Address - State:IA
Practice Address - Zip Code:52328-9536
Practice Address - Country:US
Practice Address - Phone:847-212-1521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08871261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental