Provider Demographics
NPI:1083817845
Name:MONTOURE, CHARLES E (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:MONTOURE
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 SHADY LANE
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54313-9311
Mailing Address - Country:US
Mailing Address - Phone:920-499-3721
Mailing Address - Fax:920-499-7502
Practice Address - Street 1:2000 SHADY LANE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54313-9311
Practice Address - Country:US
Practice Address - Phone:920-499-3721
Practice Address - Fax:920-499-7502
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI38601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics