1225194640 NPI number — ERIN OLIVIA MONDESIR DDS

Table of content: ERIN OLIVIA MONDESIR DDS (NPI 1225194640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225194640 NPI number — ERIN OLIVIA MONDESIR DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONDESIR
Provider First Name:
ERIN
Provider Middle Name:
OLIVIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1225194640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2221 E BIJOU ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909-8009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-576-1850
Provider Business Mailing Address Fax Number:
719-955-9470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5632 THE ALAMEDA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-485-0008
Provider Business Practice Location Address Fax Number:
410-435-0444
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  12218 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1225194640 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com