Healthcare Provider Details

I. General information

NPI: 1083775795
Provider Name (Legal Business Name): TIMOTHY VINCENT MONROE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 E STATE ST
ATHENS OH
45701-1819
US

IV. Provider business mailing address

410 E STATE ST
ATHENS OH
45701-1819
US

V. Phone/Fax

Practice location:
  • Phone: 740-594-8207
  • Fax: 740-592-5931
Mailing address:
  • Phone: 740-594-8207
  • Fax: 740-592-5931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number17221
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: