Provider Demographics
NPI:1609494137
Name:MONTERO, SANDORF (DMD)
Entity Type:Individual
Prefix:
First Name:SANDORF
Middle Name:
Last Name:MONTERO
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 1:11300 NW 87TH CT STE 166
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4521
Mailing Address - Country:US
Mailing Address - Phone:786-702-5643
Mailing Address - Fax:305-364-0983
Practice Address - Street 1:11300 NW 87TH CT STE 166
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4521
Practice Address - Country:US
Practice Address - Phone:786-702-5643
Practice Address - Fax:305-364-0983
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN251731223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN25173OtherLICENSE NUMBER