Healthcare Provider Details

I. General information

NPI: 1790980704
Provider Name (Legal Business Name): ANAMARIA MUNOZ DDS., MS.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E 75TH ST
NEW YORK NY
10021-2706
US

IV. Provider business mailing address

57 E 75TH ST
NEW YORK NY
10021-2706
US

V. Phone/Fax

Practice location:
  • Phone: 212-472-3100
  • Fax: 212-472-3102
Mailing address:
  • Phone: 212-472-3100
  • Fax: 212-472-3102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number046074-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: