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General NPI Number Information
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NPI Number | 1245612282
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Entity Type | Individual
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Provider Name | MONICA HENAO D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 618 LAKESTONE COMMONS AVE
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-7386
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Country | US
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Telephone | 984-326-8443
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Fax | 984-326-7771
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Provider Business Mailing Address
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Address Line | 618 LAKESTONE COMMONS AVE
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City | FUQUAY VARINA
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State | NC
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Zip | 27526-7386
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Country | US
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Telephone | 984-326-8443
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Fax | 984-326-7771
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1856930
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 10195
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10195
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License Number State | NC
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