Provider Demographics
NPI:1184158214
Name:AMY M. MUNSELLE, DDS, INC
Entity type:Organization
Organization Name:AMY M. MUNSELLE, DDS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MUNSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-433-2425
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:707-433-6824
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-15
Last Update Date:2017-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57407261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental