Provider Demographics
NPI:1669501763
Name:SMITH, MONTE JOHN (DDS)
Entity Type:Individual
Prefix:
First Name:MONTE
Middle Name:JOHN
Last Name:SMITH
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 1:11342 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946
Mailing Address - Country:US
Mailing Address - Phone:530-432-3280
Mailing Address - Fax:916-933-4216
Practice Address - Street 1:11342 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-9440
Practice Address - Country:US
Practice Address - Phone:530-432-3280
Practice Address - Fax:916-933-4216
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice