Healthcare Provider Details

I. General information

NPI: 1013105642
Provider Name (Legal Business Name): DBA MICHELLE MUNOZ, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 N 4TH ST
UVALDE TX
78801-4014
US

IV. Provider business mailing address

836 N 4TH ST
UVALDE TX
78801-4014
US

V. Phone/Fax

Practice location:
  • Phone: 830-278-4444
  • Fax: 830-278-6300
Mailing address:
  • Phone: 830-278-4444
  • Fax: 830-278-6300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number20519
License Number StateTX

VIII. Authorized Official

Name: DR. MICHELLE MUNOZCRUCE
Title or Position: DOCTOR
Credential:
Phone: 830-278-4444