Provider Demographics
NPI:1811043714
Name:KUMAR, MONIKA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:
Last Name:KUMAR
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 1:3330 YOUREE DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2116
Mailing Address - Country:US
Mailing Address - Phone:318-286-5810
Mailing Address - Fax:318-861-9227
Practice Address - Street 1:3330 YOUREE DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2116
Practice Address - Country:US
Practice Address - Phone:318-286-5810
Practice Address - Fax:318-861-9227
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA55731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice