Provider Demographics
NPI:1912188004
Name:THOMASIAN, MONIQUE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:S
Last Name:THOMASIAN
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 1:9516 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2084
Mailing Address - Country:US
Mailing Address - Phone:301-299-5060
Mailing Address - Fax:
Practice Address - Street 1:9516 FOX HOLLOW DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2084
Practice Address - Country:US
Practice Address - Phone:301-299-5060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-17
Last Update Date:2007-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD116551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice