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General NPI Number Information
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NPI Number | 1194381418
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Entity Type | Individual
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Provider Name | REBECCA MONTICELLO DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 02/14/2023
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Provider Practice Location Address
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Address Line | 1750 GRAND RIDGE CT NE STE 300
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-7043
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Country | US
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Telephone | 616-364-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 GRAND RIDGE CT NE STE 300
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-7043
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Country | US
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Telephone | 616-364-1700
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2901600173
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License Number State | MI
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