Provider Demographics
NPI:1720111503
Name:MONTI MARKOWSKI, DIANE T (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:T
Last Name:MONTI MARKOWSKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ASHBROOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02921
Mailing Address - Country:US
Mailing Address - Phone:401-459-1757
Mailing Address - Fax:401-459-1220
Practice Address - Street 1:931 SMITH STREET
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02908
Practice Address - Country:US
Practice Address - Phone:401-521-5528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2008122300000X
MA17522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist