Healthcare Provider Details

I. General information

NPI: 1356609226
Provider Name (Legal Business Name): JOSE MONTERO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 N KENDALL DR STE 604E
MIAMI FL
33176-2175
US

IV. Provider business mailing address

8940 N KENDALL DR STE 604E
MIAMI FL
33176-2175
US

V. Phone/Fax

Practice location:
  • Phone: 305-595-1905
  • Fax: 305-595-2219
Mailing address:
  • Phone: 305-595-1905
  • Fax: 305-595-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberDN23226
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN23226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: