Provider Demographics
NPI:1073101507
Name:MUNOZ FAMILY AND COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:MUNOZ FAMILY AND COSMETIC DENTISTRY
Other - Org Name:CENTER FOR DENTAL EXCELLENCE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-662-1440
Mailing Address - Street 1:410 SECURITY BLVD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-9705
Mailing Address - Country:US
Mailing Address - Phone:920-662-1440
Mailing Address - Fax:
Practice Address - Street 1:410 SECURITY BLVD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-9705
Practice Address - Country:US
Practice Address - Phone:920-662-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-10
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental