Provider Demographics
NPI:1518314087
Name:MUNOZ, BRIANNA (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BRIANNA
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LISE CIR
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-1381
Mailing Address - Country:US
Mailing Address - Phone:508-873-0597
Mailing Address - Fax:
Practice Address - Street 1:34 DALE RD STE 108
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3659
Practice Address - Country:US
Practice Address - Phone:860-674-0874
Practice Address - Fax:860-674-8716
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-15
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18572961223P0221X
CT121881223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric Dentistry