MEDICARE: DAVID L MUGLESTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5023	WA

General Provider Information

NPI Number	:	1033290903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L MUGLESTON

Provider Business Mailing Address
First Line	:	2302 S UNION AVE
Second Line	:	SUITE A-2
City	:	TACOMA
State	:	WA
Zip	:	98405-1300
Country	:	US
Telephone Number	:	253-752-5933
Fax Number	:	253-752-6535

Provider Business Practice Location Address
First Line	:	2302 S UNION AVE
Second Line	:	SUITE A-2
City	:	TACOMA
State	:	WA
Zip	:	98405-1300
Country	:	US
Telephone Number	:	253-752-5933
Fax Number	:	253-752-6535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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Directions to “ DAVID L MUGLESTON ” Practice Location

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