Provider Demographics
NPI:1336163997
Name:MUNTER, RICKY SCOTT (DDS)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:SCOTT
Last Name:MUNTER
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 1:24 ROCKLAND DR
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1409
Mailing Address - Country:US
Mailing Address - Phone:516-935-0066
Mailing Address - Fax:
Practice Address - Street 1:366 N BROADWAY
Practice Address - Street 2:SUITE 302
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2025
Practice Address - Country:US
Practice Address - Phone:516-935-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0362651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice