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Organization
MY MOUTH DENTAL
Active
Organization
MY MOUTH DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSE LUIS MONTOYA DDS (PRESIDENT)
(901) 340-4458
Entity
Organization
Contact information
Practice address
9101 LAKEVIEW PKWY, 200, ROWLETT, TX 75088-4540
(901) 340-4458
Mailing address
9101 LAKEVIEW PKWY, 200, ROWLETT, TX 75088-4540
(901) 340-4458
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
24453
TX
Other
Enumeration date
11/14/2011
Last updated
11/14/2011
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