Provider Demographics
NPI:1295950764
Name:MONDA, KIMBERLE IAN (D M D)
Entity type:Individual
Prefix:DR
First Name:KIMBERLE
Middle Name:IAN
Last Name:MONDA
Suffix:
Gender:F
Credentials:D M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LYNDHURST CIR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8870
Mailing Address - Country:US
Mailing Address - Phone:724-940-4213
Mailing Address - Fax:412-766-9221
Practice Address - Street 1:534 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3508
Practice Address - Country:US
Practice Address - Phone:412-766-7532
Practice Address - Fax:412-766-9221
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-026807-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA453869OtherUNITED CONCORDIA INS. CO.