MEDICARE: MONTERODENTAL GROUP

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	1223G0001X	General Practice Dentistry	19427	TX

General Provider Information

NPI Number	:	1366656605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTERODENTAL GROUP

Provider Business Mailing Address
First Line	:	9859 W IH 10 STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2272
Country	:	US
Telephone Number	:	210-696-2524
Fax Number	:	210-696-2622

Provider Business Practice Location Address
First Line	:	9859 W IH 10 STE 105
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-2272
Country	:	US
Telephone Number	:	210-696-2524
Fax Number	:	210-696-2622

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SERGIO MONTERO
Credential	:	DDS
Telephone Number	:	210-696-2524

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	08/22/2020

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