Provider Demographics
NPI:1447558960
Name:MONTOYA, SONIA E (RDH)
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:E
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:E
Other - Last Name:HEREDIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:8025 S KILBOURN AVE
Mailing Address - Street 2:6037 S. MOBILE AVE.
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-2107
Mailing Address - Country:US
Mailing Address - Phone:773-507-3406
Mailing Address - Fax:
Practice Address - Street 1:4148 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-1825
Practice Address - Country:US
Practice Address - Phone:773-507-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0200120013124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist