Provider Demographics
NPI:1588280523
Name:GIARRUSSO, MONIQUE ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:ELIZABETH
Last Name:GIARRUSSO
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 1:76495 HIGHWAY 1082
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-6709
Mailing Address - Country:US
Mailing Address - Phone:985-502-1714
Mailing Address - Fax:
Practice Address - Street 1:5842 PLANK RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70805-1320
Practice Address - Country:US
Practice Address - Phone:225-357-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA71401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice