Provider Demographics
NPI:1912032582
Name:MONTELLO, MARIA ANNE ROYBAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ANNE ROYBAL
Last Name:MONTELLO
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:PO BOX 73596
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-0120
Mailing Address - Country:US
Mailing Address - Phone:858-344-2275
Mailing Address - Fax:
Practice Address - Street 1:171 AVENIDA VAQUERO
Practice Address - Street 2:SUITE A
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3601
Practice Address - Country:US
Practice Address - Phone:949-525-3098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist