Provider Demographics
NPI:1467700286
Name:MONSON, ANDREA LEIGH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:LEIGH
Last Name:MONSON
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 1:3725 CROSSING STREET SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3859
Mailing Address - Country:US
Mailing Address - Phone:701-852-3939
Mailing Address - Fax:701-852-0126
Practice Address - Street 1:3725 CROSSING ST SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-852-3939
Practice Address - Fax:701-852-0126
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND21391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40077Medicaid
949702OtherBLUE CROSS BLUE SHIELD OF NORTH DAKOTA