Provider Demographics
NPI:1134490451
Name:STELA DIMITROVA-MUNRO, D.D.S., INC.
Entity Type:Organization
Organization Name:STELA DIMITROVA-MUNRO, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMITROVA-MUNRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-738-8452
Mailing Address - Street 1:100 N STATE COLLEGE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4236
Mailing Address - Country:US
Mailing Address - Phone:714-738-8452
Mailing Address - Fax:714-738-8512
Practice Address - Street 1:100 N STATE COLLEGE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4236
Practice Address - Country:US
Practice Address - Phone:714-738-8452
Practice Address - Fax:714-738-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56296261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental