Provider Demographics
NPI:1033570668
Name:DR. MONIQUE MCQUADE, DDS
Entity Type:Organization
Organization Name:DR. MONIQUE MCQUADE, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MCQUADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-697-0442
Mailing Address - Street 1:100 SOUTH ST
Mailing Address - Street 2:#106
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-2528
Mailing Address - Country:US
Mailing Address - Phone:917-697-0442
Mailing Address - Fax:
Practice Address - Street 1:100 SOUTH ST
Practice Address - Street 2:#106
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2528
Practice Address - Country:US
Practice Address - Phone:917-697-0442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56082122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty