Healthcare Provider Details

I. General information

NPI: 1164050365
Provider Name (Legal Business Name): MONICA PONCE, DDS, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 WEST RUSSELL ROAD SUITE 102
LAS VEGAS NV
89148-8914
US

IV. Provider business mailing address

8036 BARNDANCE CT
LAS VEGAS NV
89149-4754
US

V. Phone/Fax

Practice location:
  • Phone: 702-806-7439
  • Fax: 702-570-3424
Mailing address:
  • Phone: 702-806-7439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MONICA RENEE PONCE
Title or Position: OWNER
Credential:
Phone: 702-806-7439