Provider Demographics
NPI:1649341504
Name:MUELLER, EUGENE V (DDS)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:V
Last Name:MUELLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 HICKORY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52804-2353
Mailing Address - Country:US
Mailing Address - Phone:563-324-0212
Mailing Address - Fax:563-322-7106
Practice Address - Street 1:2228 HICKORY GROVE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-2353
Practice Address - Country:US
Practice Address - Phone:563-324-0212
Practice Address - Fax:563-322-7106
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA5711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0064691Medicaid