Provider Demographics
NPI:1972954238
Name:HEROLD, MONA BRITT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:BRITT
Last Name:HEROLD
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 1:10416 SAINT GERMAIN CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8058
Mailing Address - Country:US
Mailing Address - Phone:908-419-7988
Mailing Address - Fax:
Practice Address - Street 1:10416 SAINT GERMAIN CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8058
Practice Address - Country:US
Practice Address - Phone:908-419-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL219291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice