Provider Demographics
NPI:1760656524
Name:DAVID M. MUNRO DDS, PA
Entity Type:Organization
Organization Name:DAVID M. MUNRO DDS, PA
Other - Org Name:BOISE DENTAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUNRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-343-2280
Mailing Address - Street 1:222 N, 2ND ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702
Mailing Address - Country:US
Mailing Address - Phone:208-343-2280
Mailing Address - Fax:208-426-9306
Practice Address - Street 1:222 N 2ND ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6109
Practice Address - Country:US
Practice Address - Phone:208-343-2280
Practice Address - Fax:208-426-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD30241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty