Provider Demographics
NPI:1538393723
Name:MONCADA, SUSANA (DMD)
Entity type:Individual
Prefix:DR
First Name:SUSANA
Middle Name:
Last Name:MONCADA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6996 PIAZZA GRANDE AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8752
Mailing Address - Country:US
Mailing Address - Phone:407-294-1132
Mailing Address - Fax:407-294-1459
Practice Address - Street 1:6996 PIAZZA GRANDE AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8752
Practice Address - Country:US
Practice Address - Phone:407-294-1132
Practice Address - Fax:407-294-1459
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist