Healthcare Provider Details

I. General information

NPI: 1972591204
Provider Name (Legal Business Name): MONA AMER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 CLIFTON AVE SUITE 204
CLIFTON NJ
07013-2723
US

IV. Provider business mailing address

930 CLIFTON AVE SUITE 204
CLIFTON NJ
07013-2723
US

V. Phone/Fax

Practice location:
  • Phone: 973-777-7207
  • Fax: 973-777-7208
Mailing address:
  • Phone: 973-777-7207
  • Fax: 973-777-7208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22107
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: