1841682473 NPI number — DAVID T. MONSON DMD PSC

Table of content: MIREYA AIDEE BUENTELLO LMSW (NPI 1326852104)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841682473 NPI number — DAVID T. MONSON DMD PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID T. MONSON DMD PSC
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:
Provider Other Organization Name Type Code:
6
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:
1841682473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3620 WALDEN DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40517-2064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-797-4213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3620 WALDEN DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40517-2064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-797-4213
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MONSON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
859-797-4213

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  8604 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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