Provider Demographics
NPI:1407525769
Name:MCMONAGLE, KELLY MARIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:MARIA
Last Name:MCMONAGLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 NE 73RD ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5349
Mailing Address - Country:US
Mailing Address - Phone:484-744-8640
Mailing Address - Fax:
Practice Address - Street 1:421 NE 73RD ST APT 7
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5349
Practice Address - Country:US
Practice Address - Phone:484-744-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61201968122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist