Provider Demographics
NPI:1902335896
Name:MOON, MONICA SEON (DDS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:SEON
Last Name:MOON
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 1:707 PRESIDENT ST APT 909
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4490
Mailing Address - Country:US
Mailing Address - Phone:703-477-7008
Mailing Address - Fax:
Practice Address - Street 1:708 LISBON CENTER DR STE A-B
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:MD
Practice Address - Zip Code:21797-8633
Practice Address - Country:US
Practice Address - Phone:410-489-2650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD163751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice