Provider Demographics
NPI:1336513126
Name:JON M MONETTE DDS INC
Entity Type:Organization
Organization Name:JON M MONETTE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:MONETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-780-6266
Mailing Address - Street 1:1921 S CATALINA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5516
Mailing Address - Country:US
Mailing Address - Phone:310-375-3338
Mailing Address - Fax:310-375-3044
Practice Address - Street 1:1921 S CATALINA AVE STE 1
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5516
Practice Address - Country:US
Practice Address - Phone:310-375-3338
Practice Address - Fax:310-375-3044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40682122300000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty