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NPI Code Detail

MEDICARE: GAVIN MUNDY DMD

MEDICARE: GAVIN MUNDY DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry10358NC

General Provider Information

NPI Number : 1568823698
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAVIN MUNDY DMD
Provider Business Mailing Address
First Line : 7 PROFESSIONAL DRIVE
Second Line :
City : SNOW HILL
State : NC
Zip : 28580
Country : US
Telephone Number : 252-747-2466
Fax Number :
Provider Business Practice Location Address
First Line : 6 PROFESSIONAL DR
Second Line :
City : SNOW HILL
State : NC
Zip : 28580-1333
Country : US
Telephone Number : 252-747-3846
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2016
Last Update Date : 02/01/2023

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Directions to “ GAVIN MUNDY DMD” Practice Location

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