Provider Demographics
NPI:1265162382
Name:NIEVES MONTALVO, ALEJANDRO ANDRES (DMD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:ANDRES
Last Name:NIEVES MONTALVO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2638 NW 104TH AVE APT 106
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6305
Mailing Address - Country:US
Mailing Address - Phone:786-451-0701
Mailing Address - Fax:
Practice Address - Street 1:1012 US-98
Practice Address - Street 2:UNIT 1
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541
Practice Address - Country:US
Practice Address - Phone:786-451-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist