Healthcare Provider Details

I. General information

NPI: 1720128424
Provider Name (Legal Business Name): HALINA SWIATKOWSKI MONTANO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9045 LA FONTANA BLVD 105
BOCA RATON FL
33434-5636
US

IV. Provider business mailing address

21267 BELLECHASSE CT
BOCA RATON FL
33433-7472
US

V. Phone/Fax

Practice location:
  • Phone: 561-488-1688
  • Fax: 561-477-1002
Mailing address:
  • Phone: 561-487-3212
  • Fax: 561-477-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN14113
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: