Provider Demographics
NPI:1801073234
Name:MUELLER, KRISTIE L (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTIE
Middle Name:L
Last Name:MUELLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 N 4TH ST
Mailing Address - Street 2:PO BOX 170
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-1574
Mailing Address - Country:US
Mailing Address - Phone:309-274-3820
Mailing Address - Fax:
Practice Address - Street 1:1008 N 4TH ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-1574
Practice Address - Country:US
Practice Address - Phone:309-274-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1600001301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice