Healthcare Provider Details

I. General information

NPI: 1407904915
Provider Name (Legal Business Name): MONSERRAT JORDEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/07/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTC SIGONELLA PSC 836 BOX 2670
FPO AE
09636-9998
US

IV. Provider business mailing address

NMRTC SIGONELLA PSC 836 BOX 2670
FPO AE
09636-9998
US

V. Phone/Fax

Practice location:
  • Phone: 314-624-4872
  • Fax:
Mailing address:
  • Phone: 314-624-4872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22072
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22072
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: