Provider Demographics
NPI:1285752881
Name:MICHAEL J. MUNDENAR, D.M.D.,P.C.
Entity type:Organization
Organization Name:MICHAEL J. MUNDENAR, D.M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MUNDENAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-504-0600
Mailing Address - Street 1:606 FLORAL VALE BLVD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5528
Mailing Address - Country:US
Mailing Address - Phone:215-504-0600
Mailing Address - Fax:215-504-0951
Practice Address - Street 1:606 FLORAL VALE BLVD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5528
Practice Address - Country:US
Practice Address - Phone:215-504-0600
Practice Address - Fax:215-504-0951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-024081-L1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA68626OtherAETNA
PA00042493000OtherKHPE
PA166433OtherBLUE CROSS BLUE SHIELD
PA00042493000OtherKHPE
PAU09178Medicare UPIN