MEDICARE: DR. ROBERTO EDGARDO MONTEAGUDO D.D.S.

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	1223G0001X	General Practice Dentistry	WI4186	WI

General Provider Information

NPI Number	:	1750507356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO EDGARDO MONTEAGUDO D.D.S.

Provider Business Mailing Address
First Line	:	1469 S 70TH ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-4814
Country	:	US
Telephone Number	:	414-383-5833
Fax Number	:	414-383-0233

Provider Business Practice Location Address
First Line	:	1469 S 70TH ST
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-4814
Country	:	US
Telephone Number	:	414-383-5833
Fax Number	:	414-383-0233

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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