Provider Demographics
NPI:1497768832
Name:MONTICELLO, JOHN F (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:MONTICELLO
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Gender:M
Credentials:DDS MS
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Mailing Address - Street 1:1750 GRAND RIDGE CT NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-364-1700
Mailing Address - Fax:616-364-6890
Practice Address - Street 1:1750 GRAND RIDGE CT NE
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-364-1700
Practice Address - Fax:616-364-6890
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI29010129511223X0400X
FLDN98861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics