Provider Demographics
NPI:1790196822
Name:MONACO, JEFFREY DANIEL (DMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DANIEL
Last Name:MONACO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 MATTHEWS TOWNSHIP PKWY
Mailing Address - Street 2:#201
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105
Mailing Address - Country:US
Mailing Address - Phone:585-276-3145
Mailing Address - Fax:585-273-3485
Practice Address - Street 1:1340 MATTHEWS TOWNSHIP PKWY
Practice Address - Street 2:#201
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-847-4717
Practice Address - Fax:585-273-3485
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC104831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry