Provider Demographics
NPI:1851020747
Name:MONTALVO, GAVIN P (DDS)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:P
Last Name:MONTALVO
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 1:1600 ELIZABETH CIR UNIT B
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-1725
Mailing Address - Country:US
Mailing Address - Phone:512-410-9141
Mailing Address - Fax:
Practice Address - Street 1:2606 OSLER BLVD
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2515
Practice Address - Country:US
Practice Address - Phone:979-776-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist