Provider Demographics
NPI:1598317026
Name:MONTESINOS, ELISE BYRNES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:BYRNES
Last Name:MONTESINOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SPRING GREEN
Mailing Address - State:WI
Mailing Address - Zip Code:53588-8062
Mailing Address - Country:US
Mailing Address - Phone:608-588-2122
Mailing Address - Fax:
Practice Address - Street 1:240 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SPRING GREEN
Practice Address - State:WI
Practice Address - Zip Code:53588-8062
Practice Address - Country:US
Practice Address - Phone:608-588-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10021101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice