Provider Demographics
NPI:1811292048
Name:THOMAS W. MONAHAN, IV, DMD, PA
Entity type:Organization
Organization Name:THOMAS W. MONAHAN, IV, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:MONAHAN
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-228-7576
Mailing Address - Street 1:115 ENGLEMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-4844
Mailing Address - Country:US
Mailing Address - Phone:336-228-7576
Mailing Address - Fax:336-228-1464
Practice Address - Street 1:115 ENGLEMAN AVENUE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-4844
Practice Address - Country:US
Practice Address - Phone:336-228-7576
Practice Address - Fax:336-228-1464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910767Medicaid