Healthcare Provider Details

I. General information

NPI: 1437103272
Provider Name (Legal Business Name): ANGELA LOU MONSON DT, RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SOUTH RD
MANKATO MN
56001-7046
US

IV. Provider business mailing address

150 SOUTH RD
MANKATO MN
56001-7046
US

V. Phone/Fax

Practice location:
  • Phone: 507-389-2147
  • Fax: 507-389-5850
Mailing address:
  • Phone: 507-389-1313
  • Fax: 507-389-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5958
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License NumberDT170
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: