Provider Demographics
NPI:1265991756
Name:MUNSON, NAKESHA (RDA)
Entity type:Individual
Prefix:MRS
First Name:NAKESHA
Middle Name:
Last Name:MUNSON
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 ASHLEY ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-4743
Mailing Address - Country:US
Mailing Address - Phone:951-201-1241
Mailing Address - Fax:
Practice Address - Street 1:3150 CASE RD BLDG C
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-5552
Practice Address - Country:US
Practice Address - Phone:951-345-4386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA90239126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant