Provider Demographics
NPI:1104302777
Name:MONTERO FERNANDEZ, EDUARDO JOSE (DMD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:JOSE
Last Name:MONTERO FERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13207 REGENCY OAK LN
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2984
Mailing Address - Country:US
Mailing Address - Phone:305-606-5944
Mailing Address - Fax:
Practice Address - Street 1:13215 GRANT RD STE 600
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4094
Practice Address - Country:US
Practice Address - Phone:832-717-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX343211223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice