Provider Demographics
NPI:1972759405
Name:MUNSELLE, AMY MARGARET (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARGARET
Last Name:MUNSELLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARGARET
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3824
Mailing Address - Country:US
Mailing Address - Phone:707-433-2425
Mailing Address - Fax:
Practice Address - Street 1:125 GRANT ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3824
Practice Address - Country:US
Practice Address - Phone:707-433-2425
Practice Address - Fax:707-433-6824
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA574071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice