Provider Demographics
NPI:1316487085
Name:REM DDS, PLLC
Entity type:Organization
Organization Name:REM DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEAGUDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-623-4911
Mailing Address - Street 1:4200 E 8TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 E 8TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3715
Practice Address - Country:US
Practice Address - Phone:303-623-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REM DDS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-01
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00203014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty