Provider Demographics
NPI:1144314725
Name:MONCRIEFFE, MAXINE NATALIE (DDS)
Entity type:Individual
Prefix:DR
First Name:MAXINE
Middle Name:NATALIE
Last Name:MONCRIEFFE
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 1:250 NORTH ALAFAYA TRAIL
Mailing Address - Street 2:SUITE 125
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828
Mailing Address - Country:US
Mailing Address - Phone:407-207-4416
Mailing Address - Fax:407-482-3847
Practice Address - Street 1:250 NORTH ALAFAYA TRAIL
Practice Address - Street 2:SUITE 125
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828
Practice Address - Country:US
Practice Address - Phone:407-207-4416
Practice Address - Fax:407-482-3847
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN150521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice