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General NPI Number Information
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NPI Number | 1376085563
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Entity Type | Individual
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Provider Name | LETICIA MONTES
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Gender | Female
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Dates
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Enumeration Date | 11/06/2016
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Last Update Date | 11/06/2016
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Provider Practice Location Address
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Address Line | 3140 CLEARWATER DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-7131
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Country | US
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Telephone | 928-445-5959
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 28075
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86312-8075
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Country | US
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Telephone | 928-642-8974
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H04285
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License Number State | AZ
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