Provider Demographics
NPI:1114148269
Name:DOMENIC MONACO D.M.D., P.A.
Entity Type:Organization
Organization Name:DOMENIC MONACO D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MONACO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-889-2020
Mailing Address - Street 1:346 SOUTH AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023-1356
Mailing Address - Country:US
Mailing Address - Phone:908-889-2020
Mailing Address - Fax:908-889-8411
Practice Address - Street 1:346 SOUTH AVE STE 7
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023-1356
Practice Address - Country:US
Practice Address - Phone:908-889-2020
Practice Address - Fax:908-889-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0176571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTIN