Provider Demographics
NPI:1659548147
Name:MONTERO, SERGIO (DDS)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:MONTERO
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 1:9859 IH 10 W
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2267
Mailing Address - Country:US
Mailing Address - Phone:210-696-2524
Mailing Address - Fax:210-696-2622
Practice Address - Street 1:9859 IH 10 W
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2267
Practice Address - Country:US
Practice Address - Phone:210-696-2524
Practice Address - Fax:210-696-2622
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152962001Medicaid