MEDICARE: DRS JORGE O MONTES AND TERESA ROMERO DDS PTRS

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

General Provider Information

NPI Number	:	1689033615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRS JORGE O MONTES AND TERESA ROMERO DDS PTRS

Provider Business Mailing Address
First Line	:	6631 LAUREL CANYON BLVD
Second Line	:
City	:	NORTH 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	:
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	:	OWNER
Name	:	JORGE O MONTES
Credential	:
Telephone Number	:	818-765-6671

Provider Enumeration Date	:	02/18/2016
Last Update Date	:	02/18/2016

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