Provider Demographics
NPI:1912901901
Name:ST. JEAN, M. MONICA (DDS)
Entity Type:Individual
Prefix:DR
First Name:M.
Middle Name:MONICA
Last Name:ST. JEAN
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 1:9097 NORTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5935
Mailing Address - Country:US
Mailing Address - Phone:410-461-2593
Mailing Address - Fax:
Practice Address - Street 1:9097 NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-5935
Practice Address - Country:US
Practice Address - Phone:410-461-2593
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD95711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice