Provider Demographics
NPI:1548225733
Name:WESTON, MONTY BRETT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONTY
Middle Name:BRETT
Last Name:WESTON
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 1:215 S 4TH ST
Mailing Address - Street 2:PO BOX 326
Mailing Address - City:MONTPELIER
Mailing Address - State:ID
Mailing Address - Zip Code:83254-1591
Mailing Address - Country:US
Mailing Address - Phone:208-847-0153
Mailing Address - Fax:208-847-2938
Practice Address - Street 1:215 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:ID
Practice Address - Zip Code:83254-1591
Practice Address - Country:US
Practice Address - Phone:208-847-0153
Practice Address - Fax:208-847-2938
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-35531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice