Provider Demographics
NPI:1881717882
Name:MONIZ, SHARILYN T (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARILYN
Middle Name:T
Last Name:MONIZ
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 1:13420 RUSSET LEAF LN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4410
Mailing Address - Country:US
Mailing Address - Phone:505-363-9309
Mailing Address - Fax:
Practice Address - Street 1:3424 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4802
Practice Address - Country:US
Practice Address - Phone:619-230-5309
Practice Address - Fax:619-566-4408
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA612961223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice