Provider Demographics
NPI:1386947497
Name:MONTOYA, MIGUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:
Last Name:MONTOYA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N QUINCE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-1680
Mailing Address - Country:US
Mailing Address - Phone:760-743-6790
Mailing Address - Fax:760-743-2874
Practice Address - Street 1:82204 US HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5630
Practice Address - Country:US
Practice Address - Phone:760-775-5552
Practice Address - Fax:760-841-1982
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA600751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice