Provider Demographics
NPI:1669574166
Name:MUNCY, MARCUS K (DDS)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:K
Last Name:MUNCY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARC
Other - Middle Name:
Other - Last Name:MUNCY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:307 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-3725
Mailing Address - Country:US
Mailing Address - Phone:479-754-8818
Mailing Address - Fax:479-754-6790
Practice Address - Street 1:307 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-3725
Practice Address - Country:US
Practice Address - Phone:479-754-8818
Practice Address - Fax:479-754-6790
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58833OtherAR BC-BS PROVIDER NO.
AR692183OtherUNITED CONCORD. PROV. #