Healthcare Provider Details

I. General information

NPI: 1891141537
Provider Name (Legal Business Name): JOSHUA MUNSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9615 CALDWELL COMMONS CIR STE B
CORNELIUS NC
28031-8188
US

IV. Provider business mailing address

9615 CALDWELL COMMONS CIR STE B
CORNELIUS NC
28031-8188
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 704-765-0912
  • Fax: 704-765-0911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10579
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number10579
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: