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General NPI Number Information
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NPI Number | 1295767382
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Entity Type | Individual
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Provider Name | MARIO MONTANEZ DDS
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2436 S ACADEMY BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80916-2408
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Country | US
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Telephone | 719-391-2336
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Fax | 719-391-1625
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Provider Business Mailing Address
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Address Line | 1014 W 11TH ST
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City | LA JUNTA
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State | CO
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Zip | 81050-2659
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Country | US
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Telephone | 719-384-4614
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Fax | 719-391-1625
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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 | 8039
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DD2106
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License Number State | NM
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