Active NPI
Isatu Alet Munu
- Prosthodontics
- Friendswood, TX
National Provider Identifier
1265054407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 39345
- Practice address
- 102 W El Dorado Blvd # C1
Friendswood, TX 77546-6516 - Phone
- (281) 990-8448
- NPI assigned
- May 11, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 18414 | MD | |
| General Practice Dentistry | 1223G0001X | 22DI02793500 | NJ | |
| Prosthodontics | 1223P0700X | 39345 | TX | Primary |
Addresses
Primary practice location
102 W El Dorado Blvd # C1
Friendswood, TX 77546-6516
Mailing address
3003 Summer St
Houston, TX 77007-4896
Phone (301) 825-6599
Other practice location 1
15231 Hall Rd Unit 103
Bowie, MD 20721-3312
Phone (301) 390-1300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39345 | Medicaid | TX | |
| 22DI02793500 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18414 | MD | MD | Clinical Social Worker |
| 22DI02793500 | NJ | MD | General Practice Dentistry |
| 39345 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ivy Hill Dental Center | Multi-Specialty | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733270400000",
"number": "1265054407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3003 SUMMER ST",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770074896",
"telephone_number": "301-825-6599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 W EL DORADO BLVD # C1",
"city": "FRIENDSWOOD",
"state": "TX",
"postal_code": "775466516",
"telephone_number": "281-990-8448"
}
],
"practiceLocations": [
{
"address_1": "15231 Hall Rd Unit 103",
"address_purpose": "LOCATION",
"city": "Bowie",
"state": "MD",
"postal_code": "207213312",
"country_code": "US",
"telephone_number": "301-390-1300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MUNU",
"first_name": "ISATU",
"middle_name": "ALET",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-05-11",
"last_updated": "2024-12-04",
"certification_date": "2024-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MD",
"license": "18414",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "22DI02793500",
"primary": false
},
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "TX",
"license": "39345",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39345",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "22DI02793500",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Friendswood, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.