Provider Demographics
NPI:1275699753
Name:MONS, CARMEN DENISE (RDH, LAP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:DENISE
Last Name:MONS
Suffix:
Gender:F
Credentials:RDH, LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5876 CROWFOOT RD
Mailing Address - Street 2:
Mailing Address - City:TRAIL
Mailing Address - State:OR
Mailing Address - Zip Code:97541-9620
Mailing Address - Country:US
Mailing Address - Phone:541-878-3945
Mailing Address - Fax:541-878-2117
Practice Address - Street 1:5876 CROWFOOT RD
Practice Address - Street 2:
Practice Address - City:TRAIL
Practice Address - State:OR
Practice Address - Zip Code:97541-9620
Practice Address - Country:US
Practice Address - Phone:541-878-3945
Practice Address - Fax:541-878-2117
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3512124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist