Provider Demographics
NPI:1710326434
Name:MONTERO, LIZANIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LIZANIA
Middle Name:
Last Name:MONTERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 HWY 290 EAST
Mailing Address - Street 2:BUILDING 2, SUITE 200
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11300 HWY 290 E
Practice Address - Street 2:SUITE 200
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653
Practice Address - Country:US
Practice Address - Phone:512-765-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-15
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX288231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry