Healthcare Provider Details

I. General information

NPI: 1336513126
Provider Name (Legal Business Name): JON M MONETTE DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 S CATALINA AVE STE 1
REDONDO BEACH CA
90277-5516
US

IV. Provider business mailing address

1921 S CATALINA AVE STE 1
REDONDO BEACH CA
90277-5516
US

V. Phone/Fax

Practice location:
  • Phone: 310-375-3338
  • Fax: 310-375-3044
Mailing address:
  • Phone: 310-375-3338
  • Fax: 310-375-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40682
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number40682
License Number StateCA

VIII. Authorized Official

Name: DR. JON MARK MONETTE
Title or Position: PRESIDENT/DENTIST
Credential: D.D.S.
Phone: 310-780-6266