MEDICARE: DR. KURT MATTHEW MUEHLEISEN D.D.S

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	122300000X	Dentist	13748	MD

General Provider Information

NPI Number	:	1427117613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT MATTHEW MUEHLEISEN D.D.S

Provider Business Mailing Address
First Line	:	810 LANDMARK DR
Second Line	:	SUITE 124
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4987
Country	:	US
Telephone Number	:	410-768-0550
Fax Number	:	410-768-8971

Provider Business Practice Location Address
First Line	:	810 LANDMARK DR
Second Line	:	SUITE 124
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-4987
Country	:	US
Telephone Number	:	410-768-0550
Fax Number	:	410-768-8971

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	05/04/2015

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