Provider Demographics
NPI:1457662181
Name:MONTEIRO, CARLA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:M
Last Name:MONTEIRO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 BARNUM AVENUE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06614
Mailing Address - Country:US
Mailing Address - Phone:203-375-6090
Mailing Address - Fax:203-378-0762
Practice Address - Street 1:1825 BARNUM AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06614-5333
Practice Address - Country:US
Practice Address - Phone:203-375-6090
Practice Address - Fax:203-378-0762
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0104491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice