Provider Demographics
NPI:1285895326
Name:MADAN, MONIKA (DMD)
Entity type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:
Last Name:MADAN
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 1:700 ALBANY ST
Mailing Address - Street 2:G217
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2518
Mailing Address - Country:US
Mailing Address - Phone:617-638-4750
Mailing Address - Fax:617-638-6170
Practice Address - Street 1:700 ALBANY ST
Practice Address - Street 2:G217
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2518
Practice Address - Country:US
Practice Address - Phone:617-638-4750
Practice Address - Fax:617-638-6170
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABB1832268PMM21223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics