Provider Demographics
NPI:1750732715
Name:HART, MONICA LYNN (RDH)
Entity type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:LYNN
Last Name:HART
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E8926 REO AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBY
Mailing Address - State:WI
Mailing Address - Zip Code:54667-8159
Mailing Address - Country:US
Mailing Address - Phone:715-218-0420
Mailing Address - Fax:
Practice Address - Street 1:E8926 REO AVE
Practice Address - Street 2:
Practice Address - City:WESTBY
Practice Address - State:WI
Practice Address - Zip Code:54667-8159
Practice Address - Country:US
Practice Address - Phone:715-218-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002876124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist