Provider Demographics
NPI:1972965119
Name:FERNANDO MUNOZ DDS PA
Entity Type:Organization
Organization Name:FERNANDO MUNOZ DDS PA
Other - Org Name:FLORIDA KIDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NUMA FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-558-3757
Mailing Address - Street 1:3472 FOREST HILL BLVD # 3A
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5864
Mailing Address - Country:US
Mailing Address - Phone:561-558-3757
Mailing Address - Fax:
Practice Address - Street 1:3472 FOREST HILL BLVD # 3A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-5864
Practice Address - Country:US
Practice Address - Phone:561-558-3757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-27
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty