Provider Demographics
NPI:1659541282
Name:MICHELE R MONTEITH D.D.S. LLC
Entity Type:Organization
Organization Name:MICHELE R MONTEITH D.D.S. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:RENE'
Authorized Official - Last Name:MONTEITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-998-8990
Mailing Address - Street 1:2420 RAVINE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7650
Mailing Address - Country:US
Mailing Address - Phone:847-998-8990
Mailing Address - Fax:847-832-9309
Practice Address - Street 1:2420 RAVINE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7650
Practice Address - Country:US
Practice Address - Phone:847-998-8990
Practice Address - Fax:847-832-9309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental