Healthcare Provider Details

I. General information

NPI: 1891254546
Provider Name (Legal Business Name): MONICA SIDHOM ATALLAH DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 06/11/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MILITARY TRL STE 220
JUPITER FL
33458-4813
US

IV. Provider business mailing address

145 E NIGHTINGALE WAY
GALLOWAY NJ
08205-6210
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4242
  • Fax:
Mailing address:
  • Phone: 609-513-9806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: