Provider Demographics
NPI:1245432046
Name:MONTALBAN, GLORIA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:S
Last Name:MONTALBAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:GLORIA
Other - Middle Name:S
Other - Last Name:MONTALBAN-HAMM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:453 ROUTE 202
Mailing Address - Street 2:
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822-6022
Mailing Address - Country:US
Mailing Address - Phone:908-284-5050
Mailing Address - Fax:908-284-5057
Practice Address - Street 1:269 ROUTE 31 SOUTH
Practice Address - Street 2:SUITE 6
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882
Practice Address - Country:US
Practice Address - Phone:908-689-5129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI 0201861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice