Provider Demographics
NPI:1215166061
Name:MONTES, GUILLERMO (MD, DDS)
Entity type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:MONTES
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 EL PASEO ST
Mailing Address - Street 2:APT 35111
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-3089
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:407-648-3686
Practice Address - Street 1:1205 LAKE ROAD
Practice Address - Street 2:CEDAR LAKE DENTAL
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568
Practice Address - Country:US
Practice Address - Phone:409-938-8018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX323981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice