Healthcare Provider Details

I. General information

NPI: 1376537258
Provider Name (Legal Business Name): CARRIE M MUEHLENPFORT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 PALMS MARINE CORPS BASE 23 DENTAL COMPANY
29 PALMS CA
92278
US

IV. Provider business mailing address

185 RIVER ROCK CT
SANTEE CA
92071-6940
US

V. Phone/Fax

Practice location:
  • Phone: 760-830-7054
  • Fax: 760-830-7074
Mailing address:
  • Phone: 760-830-7054
  • Fax: 760-830-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number52518
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: