Provider Demographics
NPI:1912015579
Name:MONTZ, RICHARD C (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:MONTZ
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 1:189 S HWY 17/92
Mailing Address - Street 2:STE. 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12366122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist