Provider Demographics
NPI:1225259138
Name:MONACO, DOMENIC (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOMENIC
Middle Name:
Last Name:MONACO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 SOUTH AVE. SUITE 7
Mailing Address - Street 2:
Mailing Address - City:FANWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07023
Mailing Address - Country:US
Mailing Address - Phone:908-889-2020
Mailing Address - Fax:908-889-8411
Practice Address - Street 1:346 SOUTH AVE. SUITE 7
Practice Address - Street 2:
Practice Address - City:FANWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07023
Practice Address - Country:US
Practice Address - Phone:908-889-2020
Practice Address - Fax:908-889-8411
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI017657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist