Provider Demographics
NPI:1497932263
Name:MUNK & ASSOCIATES ORTHODONTICS PLLC
Entity Type:Organization
Organization Name:MUNK & ASSOCIATES ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WAKEFIELD
Authorized Official - Last Name:MUNK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:248-625-0880
Mailing Address - Street 1:5825 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2983
Mailing Address - Country:US
Mailing Address - Phone:248-625-0880
Mailing Address - Fax:248-625-0828
Practice Address - Street 1:5825 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2983
Practice Address - Country:US
Practice Address - Phone:248-625-0880
Practice Address - Fax:248-625-0828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010182921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty