=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093809931
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALICIA MONTELL DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 MONUMENT BLVD STE 8
-----------------------------------------------------
City | PLEASANT HILL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-363-1256
-----------------------------------------------------
Fax | 925-356-2499
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1515 FRUITVALE AVE
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-535-4000
-----------------------------------------------------
Fax | 510-535-4128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DDS54019
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------