Provider Demographics
NPI:1790866978
Name:MONETTE, JON MARK (DDS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:MARK
Last Name:MONETTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 S. CATALINA AVE STE. 1
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5516
Mailing Address - Country:US
Mailing Address - Phone:310-375-3338
Mailing Address - Fax:310-375-3044
Practice Address - Street 1:1921 S CATALINA AVE STE 1
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5516
Practice Address - Country:US
Practice Address - Phone:310-375-3338
Practice Address - Fax:310-375-3044
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA406821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice