Healthcare Provider Details

I. General information

NPI: 1063518553
Provider Name (Legal Business Name): CINDY MUNOZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 E NEW CIRCLE ROAD
LEXINGTON KY
40511-2275
US

IV. Provider business mailing address

2312 REMINGTON WAY APT 1102
LEXINGTON KY
40511-2276
US

V. Phone/Fax

Practice location:
  • Phone: 859-396-7563
  • Fax:
Mailing address:
  • Phone: 859-396-7563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number8219
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8219
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: