Provider Demographics
NPI:1881643963
Name:MONAK, EDMUND GEORGE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:GEORGE
Last Name:MONAK
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2930 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-1011
Mailing Address - Country:US
Mailing Address - Phone:970-353-9403
Mailing Address - Fax:970-353-9906
Practice Address - Street 1:1006 A ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-2021
Practice Address - Country:US
Practice Address - Phone:970-352-0048
Practice Address - Fax:970-352-1120
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO86941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88505774Medicaid