Provider Demographics
NPI:1780750661
Name:YUAN, MONIQUE ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:ROSE
Last Name:YUAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:604 SOUTH FREDERICK AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877
Mailing Address - Country:US
Mailing Address - Phone:301-519-9555
Mailing Address - Fax:301-519-9554
Practice Address - Street 1:604 SOUTH FREDERICK AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877
Practice Address - Country:US
Practice Address - Phone:301-519-9555
Practice Address - Fax:301-519-9554
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD136251223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics