Provider Demographics
NPI:1871664805
Name:CAYOUETTE, MONICA JOHNSON (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:JOHNSON
Last Name:CAYOUETTE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 ASHLEY AVE # 546
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-0001
Mailing Address - Country:US
Mailing Address - Phone:843-556-3162
Mailing Address - Fax:
Practice Address - Street 1:173 ASHLEY AVE # 546
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-0001
Practice Address - Country:US
Practice Address - Phone:843-792-6451
Practice Address - Fax:843-792-1593
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC 33991223P0700X
SCPROS 05321223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics