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General NPI Number Information
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NPI Number | 1043677925
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Entity Type | Organization
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Legal Business Name | MONIKA SRIVASTAVA DMD PA EAST
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Dates
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Enumeration Date | 01/22/2016
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 10051 PINES BLVD SUITE C
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6186
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Country | US
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Telephone | 954-251-2717
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Fax | 954-613-4005
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Provider Business Mailing Address
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Address Line | 10051 PINES BLVD STE D
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6172
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Country | US
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Telephone | 954-251-2717
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Fax | 954-613-4005
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MONIKA SRIVASTAVA
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Credential | DMD
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Telephone | 215-485-7069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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