Provider Demographics
NPI:1568632461
Name:MUNNINGER, BRAD MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:MICHAEL
Last Name:MUNNINGER
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 1:300 US HIGHWAY 95A S
Mailing Address - Street 2:BUILDING A SUITE 110
Mailing Address - City:FERNLEY
Mailing Address - State:NV
Mailing Address - Zip Code:89408-9721
Mailing Address - Country:US
Mailing Address - Phone:775-575-0777
Mailing Address - Fax:
Practice Address - Street 1:300 US HIGHWAY 95A S
Practice Address - Street 2:BUILDING A SUITE 110
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-9721
Practice Address - Country:US
Practice Address - Phone:775-575-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV48601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice