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General NPI Number Information
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NPI Number | 1073783973
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Entity Type | Organization
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Legal Business Name | JAY P. MUELLER D.D.S.
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 57 E HATTENDORF AVE SUITE # 150
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City | ROSELLE
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State | IL
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Zip | 60172-1501
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Country | US
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Telephone | 630-529-1999
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Fax | 630-529-1960
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Provider Business Mailing Address
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Address Line | 57 E HATTENDORF AVE SUITE # 150
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City | ROSELLE
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State | IL
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Zip | 60172-1501
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Country | US
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Telephone | 630-529-1999
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Fax | 630-529-1960
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Authorized Official
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Title or Position | RECEPTIONIST
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Name | JANIS VILLARREAL
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Credential |
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Telephone | 630-529-1999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019-017-651
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License Number State | IL
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