Provider Demographics
NPI:1376708255
Name:MONTALVO, ALEJANDRO R (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:R
Last Name:MONTALVO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-2105
Mailing Address - Country:US
Mailing Address - Phone:610-534-0300
Mailing Address - Fax:
Practice Address - Street 1:875 MAIN ST
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-2105
Practice Address - Country:US
Practice Address - Phone:610-534-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0375321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice