Provider Demographics
NPI:1689708240
Name:MUNSON, ROBERT PIERCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PIERCE
Last Name:MUNSON
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:PO BOX 322
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05033-0322
Mailing Address - Country:US
Mailing Address - Phone:802-222-5594
Mailing Address - Fax:802-222-4435
Practice Address - Street 1:320 UPPER PLAIN (RTE 5)
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:VT
Practice Address - Zip Code:05033-0322
Practice Address - Country:US
Practice Address - Phone:802-222-5594
Practice Address - Fax:802-222-4435
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT9571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002486Medicaid