MEDICARE: JORDAN MUNAR

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
1	1223G0001X	General Practice Dentistry	14295901-9926	UT

General Provider Information

NPI Number	:	1720904485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN MUNAR

Provider Business Mailing Address
First Line	:	2487 CANYON CREEK RD
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92025-7462
Country	:	US
Telephone Number	:	858-444-7306
Fax Number	:

Provider Business Practice Location Address
First Line	:	2601 PAUL JONES ST
Second Line	:
City	:	GREAT LAKES
State	:	IL
Zip	:	60088-2834
Country	:	US
Telephone Number	:	847-688-2430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2026
Last Update Date	:	06/26/2026

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