Provider Demographics
NPI:1659499051
Name:MONTES, JORGE OCTAVIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:OCTAVIO
Last Name:MONTES
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 1:6631 LAUREL CANYON BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NO HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1546
Mailing Address - Country:US
Mailing Address - Phone:818-765-6671
Mailing Address - Fax:818-765-4340
Practice Address - Street 1:6631 LAUREL CANYON BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1546
Practice Address - Country:US
Practice Address - Phone:818-765-6671
Practice Address - Fax:818-765-4340
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADH033499122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3351001OtherMEDICAL DENTICAL