Provider Demographics
NPI:1992910467
Name:MONGE, JASON MARIO (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MARIO
Last Name:MONGE
Suffix:
Gender:
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARIO
Other - Middle Name:
Other - Last Name:MONGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2112 DANVILLE RD SW STE A
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4673
Mailing Address - Country:US
Mailing Address - Phone:256-353-8696
Mailing Address - Fax:256-353-7388
Practice Address - Street 1:2112 DANVILLE RD SW STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4673
Practice Address - Country:US
Practice Address - Phone:256-353-8696
Practice Address - Fax:256-353-7388
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice