Healthcare Provider Details

I. General information

NPI: 1811005168
Provider Name (Legal Business Name): LOUIS MONTELEONE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 W ESTRELLA ST SUITE B
TAMPA FL
33629-5700
US

IV. Provider business mailing address

4014 W ESTRELLA ST SUITE B
TAMPA FL
33629-5700
US

V. Phone/Fax

Practice location:
  • Phone: 813-250-9440
  • Fax: 813-250-9442
Mailing address:
  • Phone: 813-250-9440
  • Fax: 813-250-9442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN002392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: