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NPI Code Detail

MEDICARE: MS. SONIA E MONTOYA RDH

MEDICARE: MS. SONIA E MONTOYA RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental Hygienist0200120013IL

General Provider Information

NPI Number : 1447558960
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SONIA E MONTOYA RDH
Provider Business Mailing Address
First Line : 8025 S KILBOURN AVE
Second Line : 6037 S. MOBILE AVE.
City : CHICAGO
State : IL
Zip : 60652-2107
Country : US
Telephone Number : 773-507-3406
Fax Number :
Provider Business Practice Location Address
First Line : 4148 S ARCHER AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60632-1825
Country : US
Telephone Number : 773-507-3406
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2011
Last Update Date : 03/08/2011

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