Provider Demographics
NPI:1942853155
Name:MONTOYA, JAIRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAIRO
Middle Name:
Last Name:MONTOYA
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 1:6245 RUFE SNOW DR STE 240
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-3350
Mailing Address - Country:US
Mailing Address - Phone:817-985-7550
Mailing Address - Fax:
Practice Address - Street 1:6245 RUFE SNOW DR STE 240
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-3350
Practice Address - Country:US
Practice Address - Phone:817-985-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014166641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry