Provider Demographics
NPI:1902335896
Name:MOON, MONICA SEON (DDS)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:SEON
Last Name:MOON
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9357 TOVITO DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3824
Mailing Address - Country:US
Mailing Address - Phone:703-477-7008
Mailing Address - Fax:
Practice Address - Street 1:1600 DUKE ST STE 150
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-6122
Practice Address - Country:US
Practice Address - Phone:703-276-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163751223G0001X
VA04014163291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral Practice