MEDICARE: DR. JORGE OCTAVIO MONTES 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	DH033499	CA
2	1223G0001X	General Practice Dentistry	DH033499	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B3351001	OTHER	CA	MEDICAL DENTICAL

General Provider Information

NPI Number	:	1659499051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORGE OCTAVIO MONTES DDS

Provider Business Mailing Address
First Line	:	6631 LAUREL CANYON BLVD
Second Line	:	2ND FLOOR
City	:	NO HOLLYWOOD
State	:	CA
Zip	:	91606-1546
Country	:	US
Telephone Number	:	818-765-6671
Fax Number	:	818-765-4340

Provider Business Practice Location Address
First Line	:	6631 LAUREL CANYON BLVD
Second Line	:	2ND FLOOR
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91606-1546
Country	:	US
Telephone Number	:	818-765-6671
Fax Number	:	818-765-4340

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	08/16/2017

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