Provider Demographics
NPI:1689750937
Name:MUNCH, ELIZABETH JOAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JOAN
Last Name:MUNCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 PRAIRIE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH SIOUX CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57049
Mailing Address - Country:US
Mailing Address - Phone:402-670-3968
Mailing Address - Fax:402-494-3002
Practice Address - Street 1:3220 PLAZA DR.
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776
Practice Address - Country:US
Practice Address - Phone:402-494-2144
Practice Address - Fax:402-494-3002
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA070128Medicaid
NE05844OtherBLUE CROSS BLUE SHIELD
NE10025384100Medicaid