Provider Demographics
NPI:1043471683
Name:JORGE MUNOZ DMD PA
Entity Type:Organization
Organization Name:JORGE MUNOZ DMD PA
Other - Org Name:SMILES OF SAN ANTONIO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:210-681-9780
Mailing Address - Street 1:8105 CULEBRA ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1624
Mailing Address - Country:US
Mailing Address - Phone:210-681-9780
Mailing Address - Fax:210-681-7029
Practice Address - Street 1:8105 CULEBRA ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1624
Practice Address - Country:US
Practice Address - Phone:210-681-9780
Practice Address - Fax:210-681-7029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19985122300000X
TX13580122300000X
TX23474122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty