Provider Demographics
NPI:1215350335
Name:ARRAVAL, MONIQUE (DDS)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:ARRAVAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 NEWTOWN AVE
Mailing Address - Street 2:STE. 800
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1350
Mailing Address - Country:US
Mailing Address - Phone:718-728-8877
Mailing Address - Fax:718-728-6795
Practice Address - Street 1:3119 NEWTOWN AVE
Practice Address - Street 2:STE. 800
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1350
Practice Address - Country:US
Practice Address - Phone:718-728-8877
Practice Address - Fax:718-728-6795
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0436221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice