Provider Demographics
NPI:1134192883
Name:MONTI, MICHAEL JOHN (DDS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:MONTI
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 1:825 NICOLLET MALL
Mailing Address - Street 2:#1009
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55402
Mailing Address - Country:US
Mailing Address - Phone:612-333-5711
Mailing Address - Fax:612-344-1596
Practice Address - Street 1:825 NICOLLET MALL
Practice Address - Street 2:#1009
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55402
Practice Address - Country:US
Practice Address - Phone:612-333-5711
Practice Address - Fax:612-344-1596
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN066818400Medicaid