Provider Demographics
NPI:1669238960
Name:MONTALVO DENTAL PLLC
Entity type:Organization
Organization Name:MONTALVO DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:956-357-1132
Mailing Address - Street 1:500 W BUSINESS 77
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W BUSINESS 77
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586
Practice Address - Country:US
Practice Address - Phone:956-357-1132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental