Provider Demographics
NPI:1124111828
Name:MONTANO, RONALD R (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:R
Last Name:MONTANO
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 1:310 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512
Mailing Address - Country:US
Mailing Address - Phone:203-469-8057
Mailing Address - Fax:203-469-8058
Practice Address - Street 1:310 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512
Practice Address - Country:US
Practice Address - Phone:203-469-8057
Practice Address - Fax:203-469-8058
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT41841223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT190001014OtherHOSPITAL OF SAINT RAPHAEL MEDICARE PIN
CT190001014OtherHOSPITAL OF SAINT RAPHAEL MEDICARE PIN
CT190000919Medicare ID - Type Unspecified