Provider Demographics
NPI:1033244900
Name:BAZAN, MONICA ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:ELIZABETH
Last Name:BAZAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4739 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6917
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1075 KINWEST PKWY
Practice Address - Street 2:100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3407
Practice Address - Country:US
Practice Address - Phone:972-506-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics