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General NPI Number Information
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NPI Number | 1619473329
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Entity Type | Organization
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Legal Business Name | M&T DENTAL SERVICES
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 2859 E FOUNTAIN BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-2312
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Country | US
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Telephone | 719-358-6379
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Fax |
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Provider Business Mailing Address
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Address Line | 10 RITO GUICU
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City | SANTA FE
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State | NM
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Zip | 87507-4301
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Country | US
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Telephone | 505-467-9383
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIO MONTANEZ
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Credential | DDS
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Telephone | 505-467-9383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 8039
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License Number State | CO
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