Provider Demographics
NPI:1639657596
Name:SISON, MONIQUE (DDS)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:SISON
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 1:8931 MEADOWBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1617
Mailing Address - Country:US
Mailing Address - Phone:714-272-4783
Mailing Address - Fax:
Practice Address - Street 1:2500 W LINCOLN AVE STE 2
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-6421
Practice Address - Country:US
Practice Address - Phone:714-761-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1029491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice