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General NPI Number Information
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NPI Number | 1205115862
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Entity Type | Organization
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Legal Business Name | A. GERRY MONTILLO DMD PC
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Dates
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Enumeration Date | 08/12/2011
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Last Update Date | 08/12/2011
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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 | 420 WASHINGTON ST STE 101
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City | BRAINTREE
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State | MA
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Zip | 02184-4773
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Country | US
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Telephone | 781-848-2422
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERARDO MONTILLO
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Credential | DMD
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Telephone | 781-848-2422
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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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