Provider Demographics
NPI:1861016529
Name:MONTALVO, DAYMIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAYMIS
Middle Name:
Last Name:MONTALVO
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 1:1288 W 29TH ST APT 15
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5567
Mailing Address - Country:US
Mailing Address - Phone:786-906-8622
Mailing Address - Fax:
Practice Address - Street 1:1288 W 29TH ST APT 15
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5567
Practice Address - Country:US
Practice Address - Phone:786-906-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN24886122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist