Provider Demographics
NPI:1114424207
Name:DUCHARME, MONIKA (LLC)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:
Last Name:DUCHARME
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W HILLSBORO BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1484
Mailing Address - Country:US
Mailing Address - Phone:561-868-6618
Mailing Address - Fax:
Practice Address - Street 1:1800 W HILLSBORO BLVD STE 210
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1484
Practice Address - Country:US
Practice Address - Phone:559-679-2044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23826122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist