Healthcare Provider Details

I. General information

NPI: 1891829206
Provider Name (Legal Business Name): ROBERT J MUNOZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W ROSEBURG AVE SUITE A
MODESTO CA
95350-5028
US

IV. Provider business mailing address

4325 JACINTHE CT
MODESTO CA
95356-9775
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-3815
  • Fax: 209-579-9521
Mailing address:
  • Phone: 209-543-6990
  • Fax: 209-579-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number20236
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: