Provider Demographics
NPI:1437103272
Name:MONSON, ANGELA LOU (DT, RDH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOU
Last Name:MONSON
Suffix:
Gender:F
Credentials:DT, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7046
Mailing Address - Country:US
Mailing Address - Phone:507-389-1313
Mailing Address - Fax:507-389-5850
Practice Address - Street 1:150 SOUTH RD
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-7046
Practice Address - Country:US
Practice Address - Phone:507-389-2147
Practice Address - Fax:507-389-5850
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH5958124Q00000X
MNDT170125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No124Q00000XDental ProvidersDental Hygienist