Provider Demographics
NPI:1013114925
Name:MONZON, PEDRO JAVIER (DDS)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:JAVIER
Last Name:MONZON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 E PERU ST
Mailing Address - Street 2:PO BOX 547
Mailing Address - City:PRINCETON
Mailing Address - State:IL
Mailing Address - Zip Code:61356-2199
Mailing Address - Country:US
Mailing Address - Phone:815-879-5273
Mailing Address - Fax:815-879-5272
Practice Address - Street 1:440 E PERU ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:IL
Practice Address - Zip Code:61356-2199
Practice Address - Country:US
Practice Address - Phone:815-879-5273
Practice Address - Fax:815-879-5272
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist