Provider Demographics
NPI:1760488670
Name:COVINGTON-BURWELL, MONOSETA (DMD)
Entity Type:Individual
Prefix:DR
First Name:MONOSETA
Middle Name:
Last Name:COVINGTON-BURWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MONOSETA
Other - Middle Name:C
Other - Last Name:BURWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:20180 W 12 MILE RD
Mailing Address - Street 2:STE 3
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5412
Mailing Address - Country:US
Mailing Address - Phone:248-353-4747
Mailing Address - Fax:248-353-2297
Practice Address - Street 1:20180 W 12 MILE RD
Practice Address - Street 2:STE 3
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5412
Practice Address - Country:US
Practice Address - Phone:248-353-4747
Practice Address - Fax:248-353-2297
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010130871223G0001X
MIBOARD ELIGIBLE1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery