Healthcare Provider Details

I. General information

NPI: 1386862795
Provider Name (Legal Business Name): REID W. MONTINI, D.M.D., M.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 W UNIVERSITY AVE STE C
GAINESVILLE FL
32607-7612
US

IV. Provider business mailing address

7520 W UNIVERSITY AVE STE C
GAINESVILLE FL
32607-7612
US

V. Phone/Fax

Practice location:
  • Phone: 352-332-7911
  • Fax: 352-332-7910
Mailing address:
  • Phone: 352-332-7911
  • Fax: 352-332-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN16790
License Number StateFL

VIII. Authorized Official

Name: DR. REID WALLACE MONTINI
Title or Position: PRESIDENT
Credential: D.M.D., M.S., P.A.
Phone: 352-284-2915