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General NPI Number Information
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NPI Number | 1417572892
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Entity Type | Organization
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Legal Business Name | DEER PARK DENTAL PLLC
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 10/21/2020
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Provider Practice Location Address
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Address Line | 118 E. CRAWFORD ST.
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City | DEER PARK
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State | WA
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Zip | 99006
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Country | US
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Telephone | 509-850-8061
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 18184
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City | SPOKANE
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State | WA
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Zip | 99228-0184
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Country | US
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Telephone | 509-850-8061
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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. SANDY FLETCHER MONTANO
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Credential | DDS
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Telephone | 786-955-7284
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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 |
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License Number State |
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