Provider Demographics
NPI:1184829806
Name:MUNZ, NICOLE K (DDS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:K
Last Name:MUNZ
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 1:1084 S HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-3409
Mailing Address - Country:US
Mailing Address - Phone:614-444-0417
Mailing Address - Fax:614-444-1091
Practice Address - Street 1:1084 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-3409
Practice Address - Country:US
Practice Address - Phone:614-444-0417
Practice Address - Fax:614-444-1091
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH219401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2516932Medicaid