Provider Demographics
NPI:1578673885
Name:MUNOZ, JUAN J (DDS)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:MUNOZ
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 1:702 MCCORMICK DR
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-4338
Mailing Address - Country:US
Mailing Address - Phone:732-840-8822
Mailing Address - Fax:732-840-8863
Practice Address - Street 1:702 MCCORMICK DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-4338
Practice Address - Country:US
Practice Address - Phone:732-840-8822
Practice Address - Fax:732-840-8863
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI 0205471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice