Provider Demographics
NPI:1649646258
Name:MONSON, SETH (DMD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:MONSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 CARPENTER RD SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-3956
Mailing Address - Country:US
Mailing Address - Phone:360-480-5242
Mailing Address - Fax:
Practice Address - Street 1:2103 NORTH DIVISION ST
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-967-3416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60572166122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist