Provider Demographics
NPI:1942757588
Name:MONTEREY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:MONTEREY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANA MELISSA
Authorized Official - Middle Name:ESCOBAR
Authorized Official - Last Name:SAYOC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:408-778-8555
Mailing Address - Street 1:16985 MONTEREY RD. SUITE 300A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95037
Mailing Address - Country:US
Mailing Address - Phone:408-778-8555
Mailing Address - Fax:408-778-8558
Practice Address - Street 1:16985 MONTEREY RD STE 300A
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-5131
Practice Address - Country:US
Practice Address - Phone:408-778-8555
Practice Address - Fax:408-778-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty