Healthcare Provider Details

I. General information

NPI: 1750707832
Provider Name (Legal Business Name): EFRAIN E. MONTANEZ MORALES D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 11/03/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 AVE ANTONIO R BARCELO PLAZA EMPRESARIAL MUNICIPAL SUITE 209
CAYEY PR
00736
US

IV. Provider business mailing address

PO BOX 3172
BAYAMON PR
00960
US

V. Phone/Fax

Practice location:
  • Phone: 787-635-5050
  • Fax:
Mailing address:
  • Phone: 787-269-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3230
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number3230
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3230
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: