Provider Demographics
NPI:1184753527
Name:MUNNS, KEVIN J (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:MUNNS
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 1:4817 SIERRA DR E
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-7970
Mailing Address - Country:US
Mailing Address - Phone:715-835-5208
Mailing Address - Fax:
Practice Address - Street 1:4423 GOLF TER STE 4
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4903
Practice Address - Country:US
Practice Address - Phone:715-835-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI58571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice