Provider Demographics
NPI:1811161151
Name:PANGANIBAN-IBANEZ, MONALIZA SALISI (DDS)
Entity type:Individual
Prefix:DR
First Name:MONALIZA
Middle Name:SALISI
Last Name:PANGANIBAN-IBANEZ
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 1:50 W EDMONSTON DR STE 605
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-1254
Mailing Address - Country:US
Mailing Address - Phone:301-762-2255
Mailing Address - Fax:301-762-5173
Practice Address - Street 1:50 W EDMONSTON DR STE 605
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1254
Practice Address - Country:US
Practice Address - Phone:301-762-2255
Practice Address - Fax:301-762-5173
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist