MEDICARE: MARK MONTANO DDS

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
1	122300000X	Dentist	202903	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477987279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MONTANO DDS

Provider Business Mailing Address
First Line	:	6436 S US HIGHWAY 85-87
Second Line	:	SUITE C
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1005
Country	:	US
Telephone Number	:	719-392-5111
Fax Number	:	719-392-4143

Provider Business Practice Location Address
First Line	:	6436 S US HIGHWAY 85-87
Second Line	:	SUITE C
City	:	FOUNTAIN
State	:	CO
Zip	:	80817-1005
Country	:	US
Telephone Number	:	719-392-5111
Fax Number	:	719-392-4143

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	03/09/2017

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Directions to “ MARK MONTANO DDS” Practice Location

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