Provider Demographics
NPI:1356527675
Name:MUNK, CHARLES WAKEFIELD (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WAKEFIELD
Last Name:MUNK
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:5825 S MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2983
Mailing Address - Country:US
Mailing Address - Phone:248-625-0880
Mailing Address - Fax:248-625-0828
Practice Address - Street 1:5825 S MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2983
Practice Address - Country:US
Practice Address - Phone:248-625-0880
Practice Address - Fax:248-625-0828
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI29010182921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics