Provider Demographics
NPI:1578056909
Name:MONTALVO, MARCUS MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:MARTIN
Last Name:MONTALVO
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 1:267 N FANNIN ST
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4523
Mailing Address - Country:US
Mailing Address - Phone:956-357-1132
Mailing Address - Fax:
Practice Address - Street 1:321 S 13TH ST # 101
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-7117
Practice Address - Country:US
Practice Address - Phone:956-428-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX342311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice