Provider Demographics
NPI:1730733585
Name:MONERT ROSABAL, MARIA DE LOURDES (DDS)
Entity type:Individual
Prefix:MISS
First Name:MARIA
Middle Name:DE LOURDES
Last Name:MONERT ROSABAL
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 1:9810 VIEUX CARRE DR APT 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-3222
Mailing Address - Country:US
Mailing Address - Phone:786-486-3165
Mailing Address - Fax:
Practice Address - Street 1:3510 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-4604
Practice Address - Country:US
Practice Address - Phone:502-874-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice