Provider Demographics
NPI:1033315072
Name:DANA, MONIQUE MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:MARIA
Last Name:DANA
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 1:1306 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1503
Mailing Address - Country:US
Mailing Address - Phone:605-642-7727
Mailing Address - Fax:605-642-4344
Practice Address - Street 1:1306 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1503
Practice Address - Country:US
Practice Address - Phone:605-642-7727
Practice Address - Fax:605-642-4344
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD06311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7800180Medicaid