Provider Demographics
NPI:1154785541
Name:MONZAVI, MONA (DMD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:MONZAVI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 HIGH GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-5543
Mailing Address - Country:US
Mailing Address - Phone:805-679-1139
Mailing Address - Fax:
Practice Address - Street 1:934 21ST ST APT 5
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-3433
Practice Address - Country:US
Practice Address - Phone:805-679-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA630991223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics