Healthcare Provider Details

I. General information

NPI: 1114433646
Provider Name (Legal Business Name): MONIKA SRIVASTAVA DMD PA PLANTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2017
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 NW 100TH AVE
PLANTATION FL
33324-7008
US

IV. Provider business mailing address

104 NW 100TH AVE
PLANTATION FL
33324-7008
US

V. Phone/Fax

Practice location:
  • Phone: 954-452-9988
  • Fax: 954-452-9966
Mailing address:
  • Phone: 954-452-9988
  • Fax: 954-452-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MONIKA SRIVASTAVA
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 215-485-7069