Provider Demographics
NPI:1447398227
Name:MONTOYA, MARIO ALEJANDRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ALEJANDRO
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ORCHARD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-4004
Mailing Address - Country:US
Mailing Address - Phone:774-318-1484
Mailing Address - Fax:774-318-1485
Practice Address - Street 1:32 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4004
Practice Address - Country:US
Practice Address - Phone:774-318-1484
Practice Address - Fax:774-318-1485
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18578241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1911OtherPR DENTIST LICENCE