Organization
FAMILY DENTAL GROUP C.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER V MUNK DDS (DENTIST/PARTNER)
(203) 337-6266
Entity
Organization
Contact information
Practice address
468 CLINTON AVE, BRIDGEPORT, CT 06605-1713
(203) 337-6266
(203) 337-6261
Mailing address
468 CLINTON AVE, BRIDGEPORT, CT 06605-1713
(203) 337-6266
(203) 337-6261
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
006670
CT
1223P0300X
Periodontics
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004163002
—
CT
05
—
008008008
—
CT
Enumeration date
09/14/2006
Last updated
06/12/2014
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