Provider Demographics
NPI:1871698795
Name:MUNK, PETER V (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:V
Last Name:MUNK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06605-1713
Mailing Address - Country:US
Mailing Address - Phone:203-337-6266
Mailing Address - Fax:203-337-6261
Practice Address - Street 1:468 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06605-1713
Practice Address - Country:US
Practice Address - Phone:203-337-6266
Practice Address - Fax:203-337-6261
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0066701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2066702Medicaid