Provider Demographics
NPI:1336248178
Name:MONSALVE, CARLOS HERNANDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:HERNANDO
Last Name:MONSALVE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:13320 FRANKLIN FARM RD STE F
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4097
Mailing Address - Country:US
Mailing Address - Phone:703-481-1115
Mailing Address - Fax:703-481-1246
Practice Address - Street 1:13320 FRANKLIN FARM RD STE F
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-4097
Practice Address - Country:US
Practice Address - Phone:703-481-1115
Practice Address - Fax:703-481-1246
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN157901223P0221X
VA04014112731223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry