Healthcare Provider Details

I. General information

NPI: 1043479777
Provider Name (Legal Business Name): MONA T HADAYA D. D. S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44820 10TH ST W SUITE 101
LANCASTER CA
93534-2312
US

IV. Provider business mailing address

26439 PUFFIN PL
CANYON COUNTRY CA
91387-6390
US

V. Phone/Fax

Practice location:
  • Phone: 661-942-1181
  • Fax:
Mailing address:
  • Phone: 386-405-3969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number56976
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN18569
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: