Provider Demographics
NPI:1235679515
Name:MATTHEW A MONACO DDS,LLC
Entity Type:Organization
Organization Name:MATTHEW A MONACO DDS,LLC
Other - Org Name:MERIDIAN PARK ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MONACO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-373-6670
Mailing Address - Street 1:3465 E MERIDIAN PARK LOOP
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7264
Mailing Address - Country:US
Mailing Address - Phone:907-373-6670
Mailing Address - Fax:908-312-2525
Practice Address - Street 1:3465 E MERIDIAN PARK LOOP
Practice Address - Street 2:SUITE A
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7264
Practice Address - Country:US
Practice Address - Phone:907-373-6670
Practice Address - Fax:908-312-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty