Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 017260 | OH |
NPI | 1073658761 |
---|---|
Provider Name | Dr. Elizabeth Stockley Mueller |
First Address | Mason, OH 45040-5009 |
Second Address | Montgomery, OH 45242-7789 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017260 | OHIO BOARD LICENSE (01) | OH |
0520056 | (05) | OH |