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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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