1568098309 NPI number — MONICA PONCE, DDS, A PROFESSIONAL CORPORATION

Table of content: (NPI 1568098309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568098309 NPI number — MONICA PONCE, DDS, A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONICA PONCE, DDS, A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DELICATE DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568098309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8036 BARNDANCE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89149-4754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-806-7439
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9450 WEST RUSSELL RD
Provider Second Line Business Practice Location Address:
SUITE #103
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-827-2200
Provider Business Practice Location Address Fax Number:
705-570-3424
Provider Enumeration Date:
03/12/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PONCE
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
OWNER AND PROVIDER
Authorized Official Telephone Number:
702-806-7439

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1174598882 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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