Provider Demographics
NPI:1942428446
Name:MONTINI, REID WALLACE (DMD, MS, PA)
Entity Type:Individual
Prefix:DR
First Name:REID
Middle Name:WALLACE
Last Name:MONTINI
Suffix:
Gender:M
Credentials:DMD, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 W UNIVERSITY AVE STE C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7612
Mailing Address - Country:US
Mailing Address - Phone:352-332-7911
Mailing Address - Fax:352-332-7910
Practice Address - Street 1:7520 W UNIVERSITY AVE STE C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-7612
Practice Address - Country:US
Practice Address - Phone:352-332-7911
Practice Address - Fax:352-332-7910
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics