Provider Demographics
NPI:1982763454
Name:MONTES IMERI, ALFREDO (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:
Last Name:MONTES IMERI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 LAUREL AVE
Mailing Address - Street 2:APT 1004
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-1252
Mailing Address - Country:US
Mailing Address - Phone:612-242-0792
Mailing Address - Fax:
Practice Address - Street 1:8650 HUDSON BLVD N
Practice Address - Street 2:#105
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-9747
Practice Address - Country:US
Practice Address - Phone:651-636-1072
Practice Address - Fax:651-501-1471
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND122191223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics