Healthcare Provider Details

I. General information

NPI: 1265054407
Provider Name (Legal Business Name): ISATU ALET MUNU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 W EL DORADO BLVD # C1
FRIENDSWOOD TX
77546-6516
US

IV. Provider business mailing address

3003 SUMMER ST
HOUSTON TX
77007-4896
US

V. Phone/Fax

Practice location:
  • Phone: 281-990-8448
  • Fax:
Mailing address:
  • Phone: 301-825-6599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number18414
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI02793500
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number39345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: