Provider Demographics
NPI:1902264252
Name:MONROE FAMILY & COSMETIC DENTISTRY
Entity Type:Organization
Organization Name:MONROE FAMILY & COSMETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUR-TSAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-266-7188
Mailing Address - Street 1:2120 W SPRING ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-3900
Mailing Address - Country:US
Mailing Address - Phone:770-266-7188
Mailing Address - Fax:770-266-7159
Practice Address - Street 1:2120 W SPRING ST STE 1100
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-3900
Practice Address - Country:US
Practice Address - Phone:770-266-7188
Practice Address - Fax:770-266-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
No126800000XDental ProvidersDental AssistantGroup - Single Specialty