Healthcare Provider Details

I. General information

NPI: 1285752881
Provider Name (Legal Business Name): MICHAEL J. MUNDENAR, D.M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 FLORAL VALE BLVD
YARDLEY PA
19067-5528
US

IV. Provider business mailing address

606 FLORAL VALE BLVD
YARDLEY PA
19067-5528
US

V. Phone/Fax

Practice location:
  • Phone: 215-504-0600
  • Fax: 215-504-0951
Mailing address:
  • Phone: 215-504-0600
  • Fax: 215-504-0951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS-024081-L
License Number StatePA

VIII. Authorized Official

Name: DR. MICHAEL JOSEPH MUNDENAR
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 215-504-0600