Provider Demographics
NPI:1992846430
Name:MONTEJO-KADERA, CONSTANZA (DDS)
Entity Type:Individual
Prefix:
First Name:CONSTANZA
Middle Name:
Last Name:MONTEJO-KADERA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 KERNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-5411
Mailing Address - Country:US
Mailing Address - Phone:415-526-8559
Mailing Address - Fax:415-526-8556
Practice Address - Street 1:3110 KERNER BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-5411
Practice Address - Country:US
Practice Address - Phone:415-526-8559
Practice Address - Fax:415-526-8556
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA540181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54018OtherDENTIST