John Whelan Mueller, DDS
Individual provider Active NPI General Practice Dentistry · Lacross, WI
NPI 1164699005 · NPPES record last updated May 9, 2008
Key facts
- NPI
- 1164699005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 2346 (WI)
- Practice address
- 3143 State Rd
Suite 200
Lacross, WI 54601 - Phone
- (608) 787-1700
- Fax
- (608) 788-6563
- NPI assigned
- May 9, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2346 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Driftless Dental Care, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2346 | WI | Yes |
Addresses
Primary practice location
3143 State Rd
Suite 200
Lacross, WI 54601
Mailing address
3143 State Rd
Suite 200
Lacross, WI 54601
Phone (608) 787-1700
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 9, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.