Provider Demographics
NPI:1760621163
Name:MONTES, NIVALDO (DDS)
Entity Type:Individual
Prefix:
First Name:NIVALDO
Middle Name:
Last Name:MONTES
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 1:25 E WASHINGTON ST STE 1721
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1899
Mailing Address - Country:US
Mailing Address - Phone:312-236-3226
Mailing Address - Fax:312-236-9629
Practice Address - Street 1:25 E WASHINGTON ST STE 1721
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1899
Practice Address - Country:US
Practice Address - Phone:312-236-3226
Practice Address - Fax:312-236-9629
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019022915122300000X
IL019.022915122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist