Provider Demographics
NPI:1346770765
Name:MAILLET, MONICA PATRICIA (DMD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:PATRICIA
Last Name:MAILLET
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:PATRICIA
Other - Last Name:MAILLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:275 BILLERICA RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4167
Mailing Address - Country:US
Mailing Address - Phone:978-667-6600
Mailing Address - Fax:
Practice Address - Street 1:275 BILLERICA RD STE 2A
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-4167
Practice Address - Country:US
Practice Address - Phone:978-622-2670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857595122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist