Provider Demographics
NPI:1851308290
Name:MONTOYA, DIANNA R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:R
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 1:1105 GOLF COURSE RD SE
Mailing Address - Street 2:BLD A
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4733
Mailing Address - Country:US
Mailing Address - Phone:505-891-3190
Mailing Address - Fax:505-994-2053
Practice Address - Street 1:1105 GOLF COURSE RD SE
Practice Address - Street 2:BLD A
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4733
Practice Address - Country:US
Practice Address - Phone:505-891-3190
Practice Address - Fax:505-994-2053
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMD15601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics