Provider Demographics
NPI:1205673142
Name:MONETTE, GRACE MARIE (DDS)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:MONETTE
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 1:2839 LAKESHORE ROAD
Mailing Address - Street 2:
Mailing Address - City:APPLEGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48401
Mailing Address - Country:US
Mailing Address - Phone:313-588-0601
Mailing Address - Fax:
Practice Address - Street 1:101 HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-3117
Practice Address - Country:US
Practice Address - Phone:843-492-5861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.108561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice