Provider Demographics
NPI:1649773755
Name:CHAU, MONICA CRYSTAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:CRYSTAL
Last Name:CHAU
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 1:280 S EVERGREEN RD UNIT 1238
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5087
Mailing Address - Country:US
Mailing Address - Phone:832-863-6515
Mailing Address - Fax:
Practice Address - Street 1:1403 N LOOP 336 W STE C
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3672
Practice Address - Country:US
Practice Address - Phone:936-539-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice