Provider Demographics
NPI:1043231673
Name:MONSSEN, BRIAN CARLOS (DDS)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CARLOS
Last Name:MONSSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 FORD PKWY
Mailing Address - Street 2:STE 201
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116
Mailing Address - Country:US
Mailing Address - Phone:651-698-1242
Mailing Address - Fax:651-696-1858
Practice Address - Street 1:2221 FORD PKWY
Practice Address - Street 2:STE 201
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116
Practice Address - Country:US
Practice Address - Phone:651-698-1242
Practice Address - Fax:651-696-1858
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND10523122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist