Provider Demographics
NPI:1396109435
Name:JOHN MONTOYA DDS PC
Entity type:Organization
Organization Name:JOHN MONTOYA DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-443-1895
Mailing Address - Street 1:4770 BASELINE RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2666
Mailing Address - Country:US
Mailing Address - Phone:303-443-1895
Mailing Address - Fax:303-442-2765
Practice Address - Street 1:4770 BASELINE RD
Practice Address - Street 2:SUITE 310
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2666
Practice Address - Country:US
Practice Address - Phone:303-443-1895
Practice Address - Fax:303-442-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9350122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1942458328OtherINDIVIDUAL NPI NUMBER