Provider Demographics
NPI:1407977465
Name:MUNN, JERI B (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:B
Last Name:MUNN
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 1:22030 SHERMAN WAY
Mailing Address - Street 2:#205
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1855
Mailing Address - Country:US
Mailing Address - Phone:818-716-5011
Mailing Address - Fax:
Practice Address - Street 1:22030 SHERMAN WAY
Practice Address - Street 2:#205
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1855
Practice Address - Country:US
Practice Address - Phone:818-716-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice