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General NPI Number Information
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NPI Number | 1306717582
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Entity Type | Individual
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Provider Name | MONROE DESHAWN SUBER CRDH
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Gender | Male
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Dates
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Enumeration Date | 09/12/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1333 FAIRCHILD ST
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City | PENSACOLA
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State | FL
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Zip | 32504-6426
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Country | US
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Telephone | 870-723-6838
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Fax |
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Provider Business Mailing Address
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Address Line | USS GERALD R FORD (CVN 78) UNIT 100328
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City | FPO
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State | AE
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Zip | 09523-2800
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Country | US
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Telephone | 870-723-6838
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Fax |
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH34411
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License Number State | FL
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