Individual
DR. MARIO MONTANEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2436 S ACADEMY BLVD, COLORADO SPRINGS, CO 80916-2408
(719) 391-2336
(719) 391-1625
Mailing address
1014 W 11TH ST, LA JUNTA, CO 81050-2659
(719) 384-4614
(719) 391-1625
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8039
CO
122300000X
Dentist
DD2106
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1624385
UNITED CONCORDIA PROVIDER
CO
05
—
33079072
—
CO
Enumeration date
07/07/2006
Last updated
07/09/2007
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