Healthcare Provider Details

I. General information

NPI: 1184692626
Provider Name (Legal Business Name): JOHN F MONACELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JOHN F MONACELL, DDS, PC/ MONACELL ORTHODONTICS

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1343 E WILLIAMSBURG RD
SANDSTON VA
23150-1723
US

IV. Provider business mailing address

1343 E WILLIAMSBURG RD
SANDSTON VA
23150-1723
US

V. Phone/Fax

Practice location:
  • Phone: 804-737-6757
  • Fax: 804-737-1745
Mailing address:
  • Phone: 804-737-6757
  • Fax: 804-737-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401004464
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: