Provider Demographics
NPI:1154823847
Name:MONDA & WEISS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MONDA & WEISS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SANTUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-766-7532
Mailing Address - Street 1:534 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3559
Mailing Address - Country:US
Mailing Address - Phone:412-766-7532
Mailing Address - Fax:412-766-9221
Practice Address - Street 1:534 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3559
Practice Address - Country:US
Practice Address - Phone:412-766-7532
Practice Address - Fax:412-766-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherINSURANCE
PA=========Medicaid