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
StateLicense IDTaxonomies
TX194271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty