Provider Demographics
NPI:1982462404
Name:MONICA HENAO DMD PLLC
Entity Type:Organization
Organization Name:MONICA HENAO DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:984-326-8443
Mailing Address - Street 1:618 LAKESTONE COMMONS AVE
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7386
Mailing Address - Country:US
Mailing Address - Phone:984-326-8443
Mailing Address - Fax:
Practice Address - Street 1:618 LAKESTONE COMMONS AVE
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-7386
Practice Address - Country:US
Practice Address - Phone:984-326-8443
Practice Address - Fax:984-326-7771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty