Provider Demographics
NPI:1093256182
Name:PHILLIP MONTOYA, DDS LLC
Entity Type:Organization
Organization Name:PHILLIP MONTOYA, DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-247-3040
Mailing Address - Street 1:4951 NE GOODVIEW CIR STE C
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1999
Mailing Address - Country:US
Mailing Address - Phone:816-373-5574
Mailing Address - Fax:
Practice Address - Street 1:4951 NE GOODVIEW CIR STE C
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1999
Practice Address - Country:US
Practice Address - Phone:816-373-5574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014041731261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental