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General NPI Number Information
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NPI Number | 1164650198
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Entity Type | Individual
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Provider Name | RICHARD JOHN MONTANDON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2009
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 1859 N LAKEWOOD DR STE 101
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2661
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Country | US
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Telephone | 208-818-6527
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Fax |
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Provider Business Mailing Address
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Address Line | 1859 N LAKEWOOD DR STE 101
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2661
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Country | US
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Telephone | 208-818-6527
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60688067
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | DS039119
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | GA60690773
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License Number State | WA
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