Healthcare Provider Details

I. General information

NPI: 1558425173
Provider Name (Legal Business Name): LYLE E. MULLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7535 POPLAR AVE
GERMANTOWN TN
38138-3812
US

IV. Provider business mailing address

2121 S GERMANTOWN RD
GERMANTOWN TN
38138-3866
US

V. Phone/Fax

Practice location:
  • Phone: 901-754-4200
  • Fax: 901-754-5309
Mailing address:
  • Phone: 901-751-4200
  • Fax: 901-758-6915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2234
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: