Provider Demographics
NPI:1366228603
Name:DOUGLAS, MONIQUE KARLINE (DDS)
Entity type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:KARLINE
Last Name:DOUGLAS
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 1:660 N STATE ROAD 7 STE 12
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2117
Mailing Address - Country:US
Mailing Address - Phone:954-583-4447
Mailing Address - Fax:954-583-8641
Practice Address - Street 1:660 N STATE ROAD 7 STE 12
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2117
Practice Address - Country:US
Practice Address - Phone:954-583-4447
Practice Address - Fax:954-583-8641
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN284171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice