Provider Demographics
NPI:1891940359
Name:RICHARD C. MONTZ DDS, PA
Entity Type:Organization
Organization Name:RICHARD C. MONTZ DDS, PA
Other - Org Name:RIVER CITY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-668-2181
Mailing Address - Street 1:189 S. HWY 17/92,
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-1832
Mailing Address - Country:US
Mailing Address - Phone:386-668-2181
Mailing Address - Fax:386-668-8910
Practice Address - Street 1:189 S. HWY 17/92,
Practice Address - Street 2:STE 100
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-1832
Practice Address - Country:US
Practice Address - Phone:386-668-2181
Practice Address - Fax:386-668-8910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty