=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972965119
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FERNANDO MUNOZ DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2016
-----------------------------------------------------
Last Update Date | 03/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3472 FOREST HILL BLVD # 3A
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-5864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-558-3757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3472 FOREST HILL BLVD # 3A
-----------------------------------------------------
City | PALM SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-5864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-558-3757
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | DR. NUMA FERNANDO MUNOZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 561-558-3757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DN20523
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------