Provider Demographics
NPI:1306985999
Name:AL-DADAH, MONZER K (DDS)
Entity type:Individual
Prefix:DR
First Name:MONZER
Middle Name:K
Last Name:AL-DADAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 W FORREST HILL AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-1930
Mailing Address - Country:US
Mailing Address - Phone:309-681-0700
Mailing Address - Fax:309-681-1986
Practice Address - Street 1:2412 W FORREST HILL AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-1930
Practice Address - Country:US
Practice Address - Phone:309-681-0700
Practice Address - Fax:309-681-1986
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist