Provider Demographics
NPI:1700372885
Name:MONTOYA, MONICA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:MARIE
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 E BIJOU ST STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-8009
Mailing Address - Country:US
Mailing Address - Phone:719-576-1850
Mailing Address - Fax:719-955-3470
Practice Address - Street 1:1739 MAIN ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2035
Practice Address - Country:US
Practice Address - Phone:303-834-6400
Practice Address - Fax:303-834-6414
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN002036701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1700372885Medicaid
CO00203670OtherCO LICENSE
CO139860271OtherADA #