Provider Demographics
NPI:1356494124
Name:WOOD, MONIQUE GUILLOT (DDS)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:GUILLOT
Last Name:WOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1212
Mailing Address - Country:US
Mailing Address - Phone:612-578-4350
Mailing Address - Fax:
Practice Address - Street 1:800 LASALLE AVE STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402-2013
Practice Address - Country:US
Practice Address - Phone:612-338-4546
Practice Address - Fax:612-338-2059
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND119321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice