Provider Demographics
NPI:1447589460
Name:MUNK, LARRY LIOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:LIOR
Last Name:MUNK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 HOFF ST
Mailing Address - Street 2:
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-5645
Mailing Address - Country:US
Mailing Address - Phone:706-544-4530
Mailing Address - Fax:
Practice Address - Street 1:4405 INNKEEPER ST
Practice Address - Street 2:BLDG 4405
Practice Address - City:FT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362
Practice Address - Country:US
Practice Address - Phone:516-780-4624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-22
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0467871223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice