Healthcare Provider Details

I. General information

NPI: 1407580053
Provider Name (Legal Business Name): MONICA BENALOUL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 N NELLIS BLVD STE E2
LAS VEGAS NV
89110-5370
US

IV. Provider business mailing address

2872 GLASS VINE CT
LAS VEGAS NV
89117-3402
US

V. Phone/Fax

Practice location:
  • Phone: 702-623-2800
  • Fax:
Mailing address:
  • Phone: 727-459-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-365C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: