Provider Demographics
NPI:1881651792
Name:MUNN, JAMES WESLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WESLEY
Last Name:MUNN
Suffix:
Gender:M
Credentials:DMD
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 218
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-0218
Mailing Address - Country:US
Mailing Address - Phone:864-476-2317
Mailing Address - Fax:
Practice Address - Street 1:7 SJ WORKMAN HWY
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-8942
Practice Address - Country:US
Practice Address - Phone:864-476-2317
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ17615Medicaid