Provider Demographics
NPI:1891254546
Name:ATALLAH, MONICA SIDHOM (DDS)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:SIDHOM
Last Name:ATALLAH
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 1:145 E NIGHTINGALE WAY
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-6210
Mailing Address - Country:US
Mailing Address - Phone:609-513-9806
Mailing Address - Fax:
Practice Address - Street 1:4600 MILITARY TRL STE 220
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4813
Practice Address - Country:US
Practice Address - Phone:973-972-4242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN276451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program