Provider Demographics
NPI:1093857377
Name:MUNOZ, LOURDES EVA (DDS)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:EVA
Last Name:MUNOZ
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 1:5311 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3710
Mailing Address - Country:US
Mailing Address - Phone:520-790-2865
Mailing Address - Fax:520-571-1277
Practice Address - Street 1:350 S WILLIAMS BLVD STE 180
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-7461
Practice Address - Country:US
Practice Address - Phone:520-571-9544
Practice Address - Fax:520-571-6755
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD39981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice