Healthcare Provider Details

I. General information

NPI: 1841228715
Provider Name (Legal Business Name): JAMES THOMAS MULLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 COLLEGE AVE SUITE 201 BLDG D
MANHATTAN KS
66502-2770
US

IV. Provider business mailing address

1133 COLLEGE AVE SUITE 201 BLDG D
MANHATTAN KS
66502-2770
US

V. Phone/Fax

Practice location:
  • Phone: 785-539-7429
  • Fax: 785-539-5320
Mailing address:
  • Phone: 785-539-7429
  • Fax: 785-539-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number6633
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: