=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770316192
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. ELDIB MONORE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2024
-----------------------------------------------------
Last Update Date | 03/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5290 W BROOKSHIRE ST STE 2
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48161-3794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-242-3311
-----------------------------------------------------
Fax | 734-242-6482
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5290 W BROOKSHIRE ST STE 2
-----------------------------------------------------
City | MONROE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48161-3794
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-242-3311
-----------------------------------------------------
Fax | 734-242-6482
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECT OF BUSINESS OPERATIONS
-----------------------------------------------------
Name | MRS. KELLEY VARGA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 734-808-0000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------