Healthcare Provider Details

I. General information

NPI: 1629089651
Provider Name (Legal Business Name): MONICA H CIPES DMD MSP PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 FARMINGTON AVENUE
WEST HARTFORD CT
06119
US

IV. Provider business mailing address

798 FARMINGTON AVENUE
WEST HARTFORD CT
06119
US

V. Phone/Fax

Practice location:
  • Phone: 860-233-1589
  • Fax: 860-233-2509
Mailing address:
  • Phone: 860-233-1589
  • Fax: 860-233-2509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number005611
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5611
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: