Provider Demographics
NPI:1508905670
Name:MONTALBO, EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:MONTALBO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 STATE HIGHWAY 49
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SUTTER CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:95685-4210
Mailing Address - Country:US
Mailing Address - Phone:209-267-9300
Mailing Address - Fax:209-267-9309
Practice Address - Street 1:321 STATE HIGHWAY 49
Practice Address - Street 2:SUITE 2
Practice Address - City:SUTTER CREEK
Practice Address - State:CA
Practice Address - Zip Code:95685-4210
Practice Address - Country:US
Practice Address - Phone:209-267-9300
Practice Address - Fax:209-267-9309
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice