Provider Demographics
NPI:1053040204
Name:MUNOZ, VICTOR A (DND)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:A
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:DND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-1920
Mailing Address - Country:US
Mailing Address - Phone:860-818-9001
Mailing Address - Fax:
Practice Address - Street 1:55 PITTSFIELD RD STE 4C
Practice Address - Street 2:
Practice Address - City:LENOX
Practice Address - State:MA
Practice Address - Zip Code:01240-2185
Practice Address - Country:US
Practice Address - Phone:860-818-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2022-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist