Provider Demographics
NPI:1801441027
Name:GERALD L MUNCY D.D.S.
Entity type:Organization
Organization Name:GERALD L MUNCY D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-865-2332
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:MORENCI
Mailing Address - State:AZ
Mailing Address - Zip Code:85540-0099
Mailing Address - Country:US
Mailing Address - Phone:928-865-2332
Mailing Address - Fax:928-865-1218
Practice Address - Street 1:106 PLAZA LOOP SUITE #11
Practice Address - Street 2:
Practice Address - City:MORENCI
Practice Address - State:AZ
Practice Address - Zip Code:85540
Practice Address - Country:US
Practice Address - Phone:928-865-2332
Practice Address - Fax:928-865-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental