Provider Demographics
NPI:1164050365
Name:MONICA PONCE, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MONICA PONCE, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:DELICATE ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-806-7439
Mailing Address - Street 1:8036 BARNDANCE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4754
Mailing Address - Country:US
Mailing Address - Phone:702-806-7439
Mailing Address - Fax:
Practice Address - Street 1:9450 WEST RUSSELL ROAD SUITE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-8914
Practice Address - Country:US
Practice Address - Phone:702-806-7439
Practice Address - Fax:702-570-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental