Provider Demographics
NPI:1801201645
Name:MONTOYA, PHILLIP (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:MONTOYA
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 1:4951 NE GOODVIEW CIR STE C
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-1999
Mailing Address - Country:US
Mailing Address - Phone:816-373-5574
Mailing Address - Fax:
Practice Address - Street 1:4951 NE GOODVIEW CIR STE C
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1999
Practice Address - Country:US
Practice Address - Phone:816-373-5574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61003122300000X
MO2014041731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist