Individual
DR. MICHAEL J. MUNDENAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
DS-024081-L
PA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS024081L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00042493000
KEYSTONE HEALTH PLAN EAST
PA
01
—
166433
HIGHMARK/BLUE SHIELD
PA
01
—
68626
AETNA ID #
PA
01
—
WA190229655
MEDICARE RR #
PA
Enumeration date
07/24/2006
Last updated
06/22/2015
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