Provider Demographics
NPI:1750026720
Name:MONTENEGRO, CRISTOFFER RENE SR
Entity type:Individual
Prefix:
First Name:CRISTOFFER
Middle Name:RENE
Last Name:MONTENEGRO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-5703
Mailing Address - Country:US
Mailing Address - Phone:954-520-7096
Mailing Address - Fax:
Practice Address - Street 1:350 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-5703
Practice Address - Country:US
Practice Address - Phone:954-520-7096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29474122300000X
FL2428390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program