Provider Demographics
NPI:1386360907
Name:ZAILY MONTESINOS DDS PA
Entity type:Organization
Organization Name:ZAILY MONTESINOS DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ZAILY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTESINOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-842-2452
Mailing Address - Street 1:1000 N HIATUS RD STE 150
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3096
Mailing Address - Country:US
Mailing Address - Phone:954-842-2452
Mailing Address - Fax:954-842-2493
Practice Address - Street 1:1000 N HIATUS RD STE 150
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-3096
Practice Address - Country:US
Practice Address - Phone:954-842-2452
Practice Address - Fax:954-842-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
77745658OtherSS