MEDICARE: DR. ANTHONY JOSEPH MONTELLA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	019025251	IL

General Provider Information

NPI Number	:	1114931821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY JOSEPH MONTELLA D.D.S.

Provider Business Mailing Address
First Line	:	696 HAMPSHIRE RD
Second Line	:	SUITE 160
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2699
Country	:	US
Telephone Number	:	805-494-3377
Fax Number	:	805-494-3399

Provider Business Practice Location Address
First Line	:	696 HAMPSHIRE RD
Second Line	:	SUITE 160
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-2699
Country	:	US
Telephone Number	:	805-494-3377
Fax Number	:	805-494-3399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	08/06/2014

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