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Organization
STACEY MONTANO DDS LLC
Active
Organization
STACEY MONTANO DDS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACEY MONTANO DDS (DENTIST/OWNER)
(505) 888-3112
Entity
Organization
Contact information
Practice address
3901 GEORGIA ST NE STE G1, ALBUQUERQUE, NM 87110-1388
(505) 888-3112
Mailing address
3901 GEORGIA ST NE STE G1, ALBUQUERQUE, NM 87110-1388
(505) 888-3112
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DD3304
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609187244
INDIVIDUAL NPI
NM
Enumeration date
06/20/2018
Last updated
06/20/2018
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