Provider Demographics
NPI:1295352326
Name:MUNOZ, KENNINTHON (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNINTHON
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5064 ANNUNCIATION CIR
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9671
Mailing Address - Country:US
Mailing Address - Phone:239-919-6930
Mailing Address - Fax:
Practice Address - Street 1:5064 ANNUNCIATION CIR
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9671
Practice Address - Country:US
Practice Address - Phone:239-919-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice