Healthcare Provider Details

I. General information

NPI: 1235131392
Provider Name (Legal Business Name): MATTHEW ANTHONY MONACO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 01/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3465 E. MERIDIAN PARK LOOP SUITE A
WASILLA AK
99654
US

IV. Provider business mailing address

3465 E. MERIDIAN PARK LOOP SUITE A
WASILLA AK
99654
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-6670
  • Fax: 908-312-2525
Mailing address:
  • Phone: 907-373-6670
  • Fax: 908-312-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number142
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: