Provider Demographics
NPI:1962154849
Name:FUNYAK, NICHOLAS THEODORE (DDS)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:THEODORE
Last Name:FUNYAK
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 1:5261 BECKMAN TER
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-6235
Mailing Address - Country:US
Mailing Address - Phone:406-697-5792
Mailing Address - Fax:
Practice Address - Street 1:4425 MILITARY TRL
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4819
Practice Address - Country:US
Practice Address - Phone:561-748-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-22
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN28296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program