Provider Demographics
NPI:1487960084
Name:ESTES, MONICA (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:ESTES
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 N MAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8451
Mailing Address - Country:US
Mailing Address - Phone:843-899-7668
Mailing Address - Fax:843-899-7667
Practice Address - Street 1:2900 N MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-8451
Practice Address - Country:US
Practice Address - Phone:843-899-7668
Practice Address - Fax:843-899-7667
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20536122300000X
MADN1855391122300000X
SCDGD8749122300000X
SC87491223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist