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General NPI Number Information
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NPI Number | 1447799119
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Entity Type | Organization
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Legal Business Name | MONFREDI FAMILY DENTAL LLC
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 5212 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43228-1642
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Country | US
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Telephone | 614-878-3636
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Fax | 614-878-6224
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Provider Business Mailing Address
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Address Line | 5212 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43228-1642
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Country | US
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Telephone | 614-878-3636
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Fax | 614-878-6224
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MONICA MARIE MONFREDI
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Credential | D.D.S.
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Telephone | 330-987-9313
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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 | 30024192
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License Number State | OH
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