Provider Demographics
NPI:1134659931
Name:MUNIZ, MIRIAM RAQUEL (DDS)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:RAQUEL
Last Name:MUNIZ
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 1:7221 LAMB RD APT 1813
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1926
Mailing Address - Country:US
Mailing Address - Phone:214-545-2076
Mailing Address - Fax:
Practice Address - Street 1:9163 FM 78 STE 1
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-2148
Practice Address - Country:US
Practice Address - Phone:210-971-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX330021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice