Provider Demographics
NPI:1578560645
Name:MUNOZ, ALFREDO (DMD)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4671 OLD PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3423
Mailing Address - Country:US
Mailing Address - Phone:407-201-7910
Mailing Address - Fax:407-201-7911
Practice Address - Street 1:4671 OLD PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-3423
Practice Address - Country:US
Practice Address - Phone:407-201-7910
Practice Address - Fax:407-201-7911
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1688122300000X
FLDN17821122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist