Provider Demographics
NPI:1982978680
Name:FREDRICK A. MUELLER, D.M.D., PC
Entity Type:Organization
Organization Name:FREDRICK A. MUELLER, D.M.D., PC
Other - Org Name:MUELLER IMPLANTS AND PERIODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PC
Authorized Official - Phone:541-757-8330
Mailing Address - Street 1:2601 NW ROLLING GREEN DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3519
Mailing Address - Country:US
Mailing Address - Phone:541-757-8330
Mailing Address - Fax:541-757-0238
Practice Address - Street 1:2601 NW ROLLING GREEN DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3519
Practice Address - Country:US
Practice Address - Phone:541-757-8330
Practice Address - Fax:541-757-0238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR49591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty