Provider Demographics
NPI:1083407332
Name:CATIENZA, MONIQUE ADRIENNE LICUDINE (DDS)
Entity type:Individual
Prefix:
First Name:MONIQUE ADRIENNE
Middle Name:LICUDINE
Last Name:CATIENZA
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 1:1727 155TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-2650
Mailing Address - Country:US
Mailing Address - Phone:530-513-9590
Mailing Address - Fax:
Practice Address - Street 1:1596 2ND AVE NE STE A
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-8069
Practice Address - Country:US
Practice Address - Phone:763-689-5699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-28
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND15284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist