Healthcare Provider Details

I. General information

NPI: 1215166061
Provider Name (Legal Business Name): GUILLERMO MONTES MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2009
Last Update Date: 03/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 LAKE ROAD CEDAR LAKE DENTAL
LA MARQUE TX
77568
US

IV. Provider business mailing address

1885 EL PASEO ST APT 35111
HOUSTON TX
77054-3089
US

V. Phone/Fax

Practice location:
  • Phone: 409-938-8018
  • Fax:
Mailing address:
  • Phone:
  • Fax: 407-648-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: