Provider Demographics
NPI:1750507356
Name:MONTEAGUDO, ROBERTO EDGARDO (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:EDGARDO
Last Name:MONTEAGUDO
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 1:1469 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4814
Mailing Address - Country:US
Mailing Address - Phone:414-383-5833
Mailing Address - Fax:414-383-0233
Practice Address - Street 1:1469 S 70TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4814
Practice Address - Country:US
Practice Address - Phone:414-383-5833
Practice Address - Fax:414-383-0233
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI41861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice