Provider Demographics
NPI:1245612282
Name:HENAO, MONICA (DMD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:HENAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3525 OLD US 1 HWY # 57
Mailing Address - Street 2:
Mailing Address - City:NEW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27562-9701
Mailing Address - Country:US
Mailing Address - Phone:978-399-4382
Mailing Address - Fax:
Practice Address - Street 1:1915 W PARK DR STE 104
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3777
Practice Address - Country:US
Practice Address - Phone:336-903-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2021-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10195122300000X, 1223G0001X
MADN1856930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice