Provider Demographics
NPI:1881803302
Name:MONSON, ERIC DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAVID
Last Name:MONSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3163
Mailing Address - Country:US
Mailing Address - Phone:406-585-8489
Mailing Address - Fax:
Practice Address - Street 1:1195 STONERIDGE DR
Practice Address - Street 2:SUITE #1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-7048
Practice Address - Country:US
Practice Address - Phone:406-586-4781
Practice Address - Fax:406-586-5227
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT19601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0005511090Medicaid
MT0000111176Medicaid