Provider Demographics
NPI:1174598882
Name:PONCE, MONICA RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:RENEE
Last Name:PONCE
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 1:9450 W RUSSELL RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-5690
Mailing Address - Country:US
Mailing Address - Phone:702-570-3320
Mailing Address - Fax:702-570-3424
Practice Address - Street 1:9450 W RUSSELL RD STE 102
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5690
Practice Address - Country:US
Practice Address - Phone:702-570-3320
Practice Address - Fax:702-570-3424
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV30631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002202048Medicaid