=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104060920
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER MUNTEAN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2009
-----------------------------------------------------
Last Update Date | 02/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 SUNRISE HWY
-----------------------------------------------------
City | WEST BABYLON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11704-6009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-661-0505
-----------------------------------------------------
Fax | 631-661-1707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8346 PENELOPE AVE
-----------------------------------------------------
City | MIDDLE VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11379-2442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-326-2980
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 053065
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------