Provider Demographics
NPI:1568098309
Name:MONICA PONCE, DDS, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MONICA PONCE, DDS, A PROFESSIONAL CORPORATION
Other - Org Name:DELICATE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PONCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-806-7439
Mailing Address - Street 1:8036 BARNDANCE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4754
Mailing Address - Country:US
Mailing Address - Phone:702-806-7439
Mailing Address - Fax:
Practice Address - Street 1:9450 WEST RUSSELL RD
Practice Address - Street 2:SUITE #103
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148
Practice Address - Country:US
Practice Address - Phone:702-827-2200
Practice Address - Fax:705-570-3424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1174598882Medicaid