Provider Demographics
NPI:1194211508
Name:MONTES DE OCA CALAS, SUZET DEL CARMEN (DMD)
Entity Type:Individual
Prefix:
First Name:SUZET
Middle Name:DEL CARMEN
Last Name:MONTES DE OCA CALAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1573 SAXON BLVD STE 100&101
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5833
Mailing Address - Country:US
Mailing Address - Phone:386-222-3348
Mailing Address - Fax:
Practice Address - Street 1:1573 SAXON BLVD STE 100&101
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725
Practice Address - Country:US
Practice Address - Phone:386-218-0046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2021-01-13
Deactivation Date:2020-12-01
Deactivation Code:
Reactivation Date:2021-01-13
Provider Licenses
StateLicense IDTaxonomies
FLDN236431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice