Provider Demographics
NPI:1003046350
Name:MONTESINO DENTAL CARE CENTER
Entity Type:Organization
Organization Name:MONTESINO DENTAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:MABELLA
Authorized Official - Last Name:MONTESINO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:305-820-0068
Mailing Address - Street 1:6847 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-5337
Mailing Address - Country:US
Mailing Address - Phone:305-820-0068
Mailing Address - Fax:
Practice Address - Street 1:6847 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-5337
Practice Address - Country:US
Practice Address - Phone:305-820-0068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN127561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty