Provider Demographics
NPI:1013158435
Name:ANDRADE-MONTALVO DDS A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ANDRADE-MONTALVO DDS A PROFESSIONAL CORPORATION
Other - Org Name:DYNAMIC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-368-2500
Mailing Address - Street 1:9833 HORN RD STE A
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1945
Mailing Address - Country:US
Mailing Address - Phone:916-368-2500
Mailing Address - Fax:916-368-2504
Practice Address - Street 1:9833 HORN RD STE A
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1945
Practice Address - Country:US
Practice Address - Phone:916-368-2500
Practice Address - Fax:916-368-2504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-14
Last Update Date:2009-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty