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General NPI Number Information
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NPI Number | 1083716864
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Entity Type | Individual
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Provider Name | ALFONSO GERARDO MONTILLO D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 420 WASHINGTON ST SUITE# 101
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City | BRAINTREE
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State | MA
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Zip | 02184-4755
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Country | US
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Telephone | 781-848-2422
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Fax | 781-848-9922
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Provider Business Mailing Address
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Address Line | 230 AUSTIN ST
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City | WEST NEWTON
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State | MA
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Zip | 02465-2501
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Country | US
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Telephone | 617-630-1954
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Fax | 617-969-7827
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 18364
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License Number State | MA
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