Provider Demographics
NPI:1316431455
Name:MONTICELLO DENTISTRY PLLC
Entity type:Organization
Organization Name:MONTICELLO DENTISTRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:THIRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-997-2485
Mailing Address - Street 1:1535 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-1133
Mailing Address - Country:US
Mailing Address - Phone:850-997-2485
Mailing Address - Fax:850-997-3783
Practice Address - Street 1:1535 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1133
Practice Address - Country:US
Practice Address - Phone:850-997-2485
Practice Address - Fax:850-997-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18939261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental