Provider Demographics
NPI:1649689217
Name:HALL-CAMILLETTI, MONIKA (DDS)
Entity type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:
Last Name:HALL-CAMILLETTI
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 1:6460 N CANTON CENTER RD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2660
Mailing Address - Country:US
Mailing Address - Phone:248-470-3275
Mailing Address - Fax:
Practice Address - Street 1:6460 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2660
Practice Address - Country:US
Practice Address - Phone:248-470-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist