Basic Information
Provider Information
NPI: 1790234755
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MONROE
FirstName: STEFFANIE
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2708 PEARLAND PKWY
Address2: SUITE 220
City: PEARLAND
State: TX
PostalCode: 775815351
CountryCode: US
TelephoneNumber: 2819971943
FaxNumber:  
Practice Location
Address1: 2708 PEARLAND PKWY
Address2: SUITE 220
City: PEARLAND
State: TX
PostalCode: 775815351
CountryCode: US
TelephoneNumber: 2819971943
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/30/2016
LastUpdateDate: 09/30/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X32399TXY Dental ProvidersDentistGeneral Practice

No ID Information.


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