Provider Demographics
NPI:1497801328
Name:MONTOYA, C. PATRICK (DDS)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:PATRICK
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 1:311 ROAD 1191
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:NM
Mailing Address - Zip Code:87418-9622
Mailing Address - Country:US
Mailing Address - Phone:505-326-6702
Mailing Address - Fax:
Practice Address - Street 1:1510B E 20TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-9033
Practice Address - Country:US
Practice Address - Phone:505-327-6151
Practice Address - Fax:505-327-7580
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD17071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice