Provider Demographics
NPI:1750577136
Name:MONTILLA, RAUL FERNANDO (DMD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:FERNANDO
Last Name:MONTILLA
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 1:20 CALLE WASHINGTON APT 1B
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1535
Mailing Address - Country:US
Mailing Address - Phone:787-504-8821
Mailing Address - Fax:
Practice Address - Street 1:20 CALLE WASHINGTON
Practice Address - Street 2:APT.1-B
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1531
Practice Address - Country:US
Practice Address - Phone:787-888-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1734122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist