Provider Demographics
NPI:1306717582
Name:SUBER, MONROE DESHAWN (CRDH)
Entity type:Individual
Prefix:
First Name:MONROE
Middle Name:DESHAWN
Last Name:SUBER
Suffix:
Gender:M
Credentials:CRDH
Other - Prefix:
Other - First Name:MONROE
Other - Middle Name:DESHAWN
Other - Last Name:SUBER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRDH
Mailing Address - Street 1:USS GERALD R FORD (CVN 78)
Mailing Address - Street 2:UNIT 100328
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09523-2800
Mailing Address - Country:US
Mailing Address - Phone:870-723-6838
Mailing Address - Fax:
Practice Address - Street 1:1333 FAIRCHILD ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6426
Practice Address - Country:US
Practice Address - Phone:870-723-6838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH34411124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist