Provider Demographics
NPI:1013055888
Name:MONTALVO, MARGARITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:
Last Name:MONTALVO
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 1:163 NEWINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2359
Mailing Address - Country:US
Mailing Address - Phone:860-231-1331
Mailing Address - Fax:860-231-0363
Practice Address - Street 1:886 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2340
Practice Address - Country:US
Practice Address - Phone:860-456-1333
Practice Address - Fax:860-450-1297
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0090901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002090900Medicaid