Provider Demographics
NPI:1730196627
Name:MONICO, RAYMOND P (DMD PA)
Entity type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:P
Last Name:MONICO
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 EYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876
Mailing Address - Country:US
Mailing Address - Phone:973-584-5144
Mailing Address - Fax:973-584-0577
Practice Address - Street 1:158 EYLAND AVE
Practice Address - Street 2:
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876
Practice Address - Country:US
Practice Address - Phone:973-584-5144
Practice Address - Fax:973-584-0577
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ117651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice