Provider Demographics
NPI:1245612282
Name:HENAO, MONICA (DMD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:HENAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:618 LAKESTONE COMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7386
Mailing Address - Country:US
Mailing Address - Phone:984-326-8443
Mailing Address - Fax:984-326-7771
Practice Address - Street 1:618 LAKESTONE COMMONS AVE
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7386
Practice Address - Country:US
Practice Address - Phone:984-326-8443
Practice Address - Fax:984-326-7771
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856930122300000X
NC101951223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice