Provider Demographics
NPI:1487245577
Name:MONTIERTH, DALLIN COLE (DDS)
Entity type:Individual
Prefix:DR
First Name:DALLIN
Middle Name:COLE
Last Name:MONTIERTH
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 1:1839 E ELMWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-5814
Mailing Address - Country:US
Mailing Address - Phone:480-276-6472
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1197
Practice Address - Country:US
Practice Address - Phone:718-918-3419
Practice Address - Fax:718-918-6147
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZD0111391223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program