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General NPI Number Information
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NPI Number | 1932537883
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Entity Type | Organization
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Legal Business Name | KENT LANE MUELLER DDS, LLC
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Dates
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Enumeration Date | 10/30/2013
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 1115 EASTON RD
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1901
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Country | US
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Telephone | 215-657-5700
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Fax | 215-657-5717
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Provider Business Mailing Address
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Address Line | 1115 EASTON RD
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1901
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Country | US
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Telephone | 215-657-5700
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Fax | 215-657-5717
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENT LANE MUELLER
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Credential | DDS
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Telephone | 215-657-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS021630L
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License Number State | PA
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