Provider Demographics
NPI:1659593812
Name:MUNIZ, ANDREA
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 WESTPARK CT
Mailing Address - Street 2:STE 100
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3999
Mailing Address - Country:US
Mailing Address - Phone:817-283-1205
Mailing Address - Fax:
Practice Address - Street 1:2275 WESTPARK CT
Practice Address - Street 2:STE 100
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3999
Practice Address - Country:US
Practice Address - Phone:817-283-1205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12577124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist