Provider Demographics
NPI:1033367685
Name:MONTEZ, TONI L
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:L
Last Name:MONTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W12802 COUNTY ROAD A
Mailing Address - Street 2:
Mailing Address - City:BOWLER
Mailing Address - State:WI
Mailing Address - Zip Code:54416-9551
Mailing Address - Country:US
Mailing Address - Phone:715-793-4144
Mailing Address - Fax:715-793-4120
Practice Address - Street 1:W12802 COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416-9551
Practice Address - Country:US
Practice Address - Phone:715-793-4144
Practice Address - Fax:715-793-4120
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9759-016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33828800Medicaid