Provider Demographics
NPI:1942497136
Name:MUELLER, GLEN E (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:E
Last Name:MUELLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13096 TESSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3442
Mailing Address - Country:US
Mailing Address - Phone:314-842-0060
Mailing Address - Fax:314-842-0067
Practice Address - Street 1:13096 TESSON FERRY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3442
Practice Address - Country:US
Practice Address - Phone:314-842-0060
Practice Address - Fax:314-842-0067
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE 122261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice