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General NPI Number Information
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NPI Number | 1699268912
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Entity Type | Individual
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Provider Name | LI Z MUECKAY DDS
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 1381 S. PATRICK DR 45TH MEDICAL GROUP CLINIC, DENTAL CLINIC
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City | PATRICK AIR FORCE BASE
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State | FL
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Zip | 32925
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Country | US
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Telephone | 850-797-7733
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Fax | 321-494-6366
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Provider Business Mailing Address
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Address Line | 1381 S. PATRICK DRIVE 45TH MEDICAL GROUP, DENTAL CLINIC
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City | PATRICK AIR FORCE BASE
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State | FL
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Zip | 32925
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 00203609
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License Number State | CO
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