Provider Demographics
NPI: | 1669647335 |
---|---|
Name: | ANNA M. MUNNE, D.D.S., P.A. |
Entity type: | Organization |
Organization Name: | ANNA M. MUNNE, D.D.S., P.A. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ANNA |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | MUNNE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD, DDS, MS |
Authorized Official - Phone: | 713-795-4666 |
Mailing Address - Street 1: | 4817 MAIN |
Mailing Address - Street 2: | STE 200 |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77002-9700 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-795-4666 |
Mailing Address - Fax: | 713-795-5514 |
Practice Address - Street 1: | 4817 MAIN ST |
Practice Address - Street 2: | 200 |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77002-9700 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-795-4666 |
Practice Address - Fax: | 713-795-5514 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-04-24 |
Last Update Date: | 2011-10-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 17959 | 1223P0300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223P0300X | Dental Providers | Dentist | Periodontics | Group - Single Specialty |