Provider Demographics
NPI:1407018856
Name:MOTTOLESE, MONICA (DDS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:MOTTOLESE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ATRIUM DR STE 215
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1417
Mailing Address - Country:US
Mailing Address - Phone:518-459-4390
Mailing Address - Fax:518-459-4458
Practice Address - Street 1:3 ATRIUM DR STE 215
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1417
Practice Address - Country:US
Practice Address - Phone:518-459-4390
Practice Address - Fax:518-459-4458
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0339951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice