Healthcare Provider Details

I. General information

NPI: 1740695931
Provider Name (Legal Business Name): SANDRA MONTES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E HIGHWAY 550
BERNALILLO NM
87004-5967
US

IV. Provider business mailing address

120 E HIGHWAY 550
BERNALILLO NM
87004-5967
US

V. Phone/Fax

Practice location:
  • Phone: 505-393-5555
  • Fax:
Mailing address:
  • Phone: 505-393-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019030114
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD4101
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: