MEDICARE: DR. MUNIRA MULUKE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	17683	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	17683	OTHER	MD	DENTIST

General Provider Information

NPI Number	:	1396417168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUNIRA MULUKE DMD

Provider Business Mailing Address
First Line	:	11021 OUTPOST DR
Second Line	:
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-4807
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11021 OUTPOST DR
Second Line	:
City	:	NORTH POTOMAC
State	:	MD
Zip	:	20878-4807
Country	:	US
Telephone Number	:	859-693-3317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2021
Last Update Date	:	09/30/2021

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