Provider Demographics
NPI:1114281508
Name:MONTANO, ERIN MAILLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MAILLE
Last Name:MONTANO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 DIAMOND CIR
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-4900
Mailing Address - Country:US
Mailing Address - Phone:314-409-4009
Mailing Address - Fax:
Practice Address - Street 1:802 US HIGHWAY 491
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5388
Practice Address - Country:US
Practice Address - Phone:505-862-5018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3697122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist