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General NPI Number Information
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NPI Number | 1669787651
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Entity Type | Individual
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Provider Name | ISMAEL RAFAEL MONTANE DMD
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Gender | Male
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Dates
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Enumeration Date | 08/13/2010
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 702 KING FARM BLVD STE 160
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City | ROCKVILLE
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State | MD
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Zip | 20850-6536
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Country | US
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Telephone | 240-415-8492
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Fax | 301-694-2941
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Provider Business Mailing Address
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Address Line | 702 KING FARM BLVD STE 160
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City | ROCKVILLE
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State | MD
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Zip | 20850-6536
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Country | US
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Telephone | 240-415-8492
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Fax | 301-345-1609
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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 | DL11079
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License Number State | MA
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