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General NPI Number Information
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NPI Number | 1548700669
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Entity Type | Individual
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Provider Name | MATTHEW RAYMOND MONTENERO DDS
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Gender | Male
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Dates
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Enumeration Date | 03/08/2017
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 301 N HARRISON ST STE F
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City | PRINCETON
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State | NJ
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Zip | 08540
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Country | US
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Telephone | 609-924-0796
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Fax |
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Provider Business Mailing Address
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Address Line | 301 N HARRISON ST STE F
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City | PRINCETON
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State | NJ
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Zip | 08540-3527
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Country | US
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Telephone | 609-924-0796
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22DI02707500
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License Number State | NJ
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