Provider Demographics
NPI:1972813285
Name:MONTZ, ROGER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:MONTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2524
Mailing Address - Country:US
Mailing Address - Phone:321-725-6565
Mailing Address - Fax:
Practice Address - Street 1:524 OCEAN AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-2524
Practice Address - Country:US
Practice Address - Phone:321-725-6565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14467122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist