Provider Demographics
NPI:1942779186
Name:MONTIEL DENTAL CARE P. A
Entity Type:Organization
Organization Name:MONTIEL DENTAL CARE P. A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO MONTIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-782-8058
Mailing Address - Street 1:7713 34TH CT E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2864
Mailing Address - Country:US
Mailing Address - Phone:941-822-3309
Mailing Address - Fax:
Practice Address - Street 1:6818 14TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-5808
Practice Address - Country:US
Practice Address - Phone:941-782-8058
Practice Address - Fax:941-782-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1841786647Medicaid