Provider Demographics
NPI:1598144933
Name:CARLOS H MONSALVE, DDS,PC.
Entity Type:Organization
Organization Name:CARLOS H MONSALVE, DDS,PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MONSALVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-481-1115
Mailing Address - Street 1:13202 HUGHSMITH WAY
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4056
Mailing Address - Country:US
Mailing Address - Phone:703-481-1115
Mailing Address - Fax:
Practice Address - Street 1:13320 FRANKLIN FARM RD STE F
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4097
Practice Address - Country:US
Practice Address - Phone:703-481-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014112731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty