Provider Demographics
NPI:1790967412
Name:MONGA, RATNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RATNA
Middle Name:
Last Name:MONGA
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 1:1485 FIRST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1363
Mailing Address - Country:US
Mailing Address - Phone:917-359-7377
Mailing Address - Fax:212-472-9551
Practice Address - Street 1:1485 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1363
Practice Address - Country:US
Practice Address - Phone:212-535-4199
Practice Address - Fax:212-472-9551
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0532731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice