Provider Demographics
NPI:1669787651
Name:MONTANE, ISMAEL RAFAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:ISMAEL
Middle Name:RAFAEL
Last Name:MONTANE
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 1:702 KING FARM BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6536
Mailing Address - Country:US
Mailing Address - Phone:240-415-8492
Mailing Address - Fax:301-345-1609
Practice Address - Street 1:702 KING FARM BLVD STE 160
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6536
Practice Address - Country:US
Practice Address - Phone:240-415-8492
Practice Address - Fax:301-694-2941
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL11079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist