Provider Demographics
NPI:1811771322
Name:ISMAEL R. MONTANE, DMD LLC
Entity type:Organization
Organization Name:ISMAEL R. MONTANE, DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:ISMAEL
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:MONTANE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-608-5854
Mailing Address - Street 1:12229 BRADBURY DR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2030
Mailing Address - Country:US
Mailing Address - Phone:305-608-5854
Mailing Address - Fax:
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:305-608-5854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental