Provider Demographics
NPI:1053981639
Name:MUEHLEISE, ASHLEY KATE (DDS)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KATE
Last Name:MUEHLEISE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8022 LAKE WOOD DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-5565
Mailing Address - Country:US
Mailing Address - Phone:269-501-6364
Mailing Address - Fax:
Practice Address - Street 1:1414 E CENTRE AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4406
Practice Address - Country:US
Practice Address - Phone:269-381-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601035122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist