Provider Demographics
NPI:1073678173
Name:MONTOYA, RICHARD J (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-3623
Mailing Address - Country:US
Mailing Address - Phone:915-533-9777
Mailing Address - Fax:915-533-9778
Practice Address - Street 1:2407 E YANDELL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-3623
Practice Address - Country:US
Practice Address - Phone:915-533-9777
Practice Address - Fax:915-533-9778
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice