Lyle Kris Munk, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D204105 Issued in ID

Practice address

2588 Channing Way
Idaho Falls, ID 83404

Phone

(208) 524-3200

Fax

(208) 524-3531

NPI assigned

Nov 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Elison Oral and Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Idaho Falls, ID
  • NPI 1114255916
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417034190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2588 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-524-3200",
            "fax_number": "208-524-3531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2588 CHANNING WAY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "83404",
            "telephone_number": "208-524-3200",
            "fax_number": "208-524-3531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MUNK",
        "first_name": "LYLE",
        "middle_name": "KRIS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D204105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002667500",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "41383",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "60194",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Muhlestein
• Jonathan Alan Muir, LPC
• Sarah Jean Muirhead, RBT
• Hanna Mullen-Morzenti, LCSW
• Rosa Maria Mulser, PH.D.
• Jessica Munson Steiner
• Kyle Jacob Murchie
• Madison Murdoch
• Thomas F Murdoch, D.C.
• Isabel Amia Murdock

• Dentist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.