Provider Demographics
NPI:1003292038
Name:PRESCOTT DENTISTRY, PLLC
Entity Type:Organization
Organization Name:PRESCOTT DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:G
Authorized Official - Last Name:MONTES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-445-1660
Mailing Address - Street 1:350 WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1714
Mailing Address - Country:US
Mailing Address - Phone:928-445-1660
Mailing Address - Fax:928-771-8169
Practice Address - Street 1:350 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1714
Practice Address - Country:US
Practice Address - Phone:928-445-1660
Practice Address - Fax:928-771-8169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty