Provider Demographics
NPI:1003811241
Name:MONCUS, TARA LAMBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LAMBERT
Last Name:MONCUS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1069
Mailing Address - Street 2:
Mailing Address - City:RAINSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35986-1069
Mailing Address - Country:US
Mailing Address - Phone:256-638-3000
Mailing Address - Fax:256-638-3099
Practice Address - Street 1:371 MCCURDY AVE S
Practice Address - Street 2:
Practice Address - City:RAINSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35986-5215
Practice Address - Country:US
Practice Address - Phone:256-638-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51261223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009932625Medicaid