Provider Demographics
NPI: | 1366656605 |
---|---|
Name: | MONTERODENTAL GROUP |
Entity Type: | Organization |
Organization Name: | MONTERODENTAL GROUP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SERGIO |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MONTERO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 210-696-2524 |
Mailing Address - Street 1: | 9859 W IH 10 STE 105 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN ANTONIO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78230-2272 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 210-696-2524 |
Mailing Address - Fax: | 210-696-2622 |
Practice Address - Street 1: | 9859 W IH 10 STE 105 |
Practice Address - Street 2: | |
Practice Address - City: | SAN ANTONIO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78230-2272 |
Practice Address - Country: | US |
Practice Address - Phone: | 210-696-2524 |
Practice Address - Fax: | 210-696-2622 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-05-09 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 19427 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Multi-Specialty |