Provider Demographics
NPI:1134117443
Name:MONROY, KAREN ANN (DDS)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:MONROY
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 1:104 W COLBY ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49461-2005
Mailing Address - Country:US
Mailing Address - Phone:231-893-6075
Mailing Address - Fax:231-893-1144
Practice Address - Street 1:104 W COLBY ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-2005
Practice Address - Country:US
Practice Address - Phone:231-893-6075
Practice Address - Fax:231-893-1144
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010188481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4622519Medicaid
88170MIOtherOUTER DRIVE
381908328020OtherDENTAL BLUE
88171MIOtherCOMMERCE
D801095OtherBLUE CROSS
O1618779OtherUNITED CONCORDIA
374041755000OtherSERVICING PROVIDER NUMBER
88123MIOtherBAYSIDE
88096MIOtherWADSWORTH