Provider Demographics
NPI:1013110931
Name:BLANCAS, MONICA LOVENIA (DDS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LOVENIA
Last Name:BLANCAS
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 1:335 DOUCET RD
Mailing Address - Street 2:STE B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503
Mailing Address - Country:US
Mailing Address - Phone:337-981-8144
Mailing Address - Fax:337-981-4994
Practice Address - Street 1:335 DOUCET RD
Practice Address - Street 2:STE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-981-8144
Practice Address - Fax:337-981-4994
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA53101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice