Provider Demographics
NPI:1053360545
Name:MUNK, MALCOLM BERT (DDS)
Entity type:Individual
Prefix:DR
First Name:MALCOLM
Middle Name:BERT
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 1:4102 PINION DR, SUITE 100
Mailing Address - Street 2:10TH MDG
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-4000
Mailing Address - Country:US
Mailing Address - Phone:719-333-5190
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DR, SUITE 100
Practice Address - Street 2:10TH MDG
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-4000
Practice Address - Country:US
Practice Address - Phone:719-333-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO76571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice