Provider Demographics
NPI:1295517720
Name:MULLER, MITCHELL JAMES (DMD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:JAMES
Last Name:MULLER
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 1:1785 N WATER ST APT 1536
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-1727
Mailing Address - Country:US
Mailing Address - Phone:217-899-0693
Mailing Address - Fax:
Practice Address - Street 1:7155 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-3841
Practice Address - Country:US
Practice Address - Phone:414-352-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6001347-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist