Provider Demographics
NPI:1255004958
Name:MONCONDUIT, MINDY C
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:C
Last Name:MONCONDUIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 W. MOORE AVE
Mailing Address - Street 2:SUITE #7
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160
Mailing Address - Country:US
Mailing Address - Phone:972-563-5454
Mailing Address - Fax:
Practice Address - Street 1:1880 W MOORE AVE
Practice Address - Street 2:#7
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2365
Practice Address - Country:US
Practice Address - Phone:972-563-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX371971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty