Individual provider Active NPI

Isatu Alet Munu

  • Prosthodontics
  • Friendswood, TX
National Provider Identifier
1265054407
Registry record updated Dec 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
39345 Issued in TX
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

Updated by the provider on Dec 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 18414 MD
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 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

IdentifierTypeStateIssuer
39345MedicaidTX
22DI02793500MedicaidNJ

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

LicenseStateTypeSpecialty
18414MDMDClinical Social Worker
22DI02793500NJMDGeneral Practice Dentistry
39345TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivy Hill Dental Center Multi-Specialty PastSince May 1, 2020 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.

Verify at the official NPI Registry.