Provider Demographics
NPI:1588717094
Name:BECHTOLD, MONTY D (DDS)
Entity type:Individual
Prefix:DR
First Name:MONTY
Middle Name:D
Last Name:BECHTOLD
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 1:640 E SIOUX AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3300
Mailing Address - Country:US
Mailing Address - Phone:605-224-5355
Mailing Address - Fax:605-224-4846
Practice Address - Street 1:640 E SIOUX AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3300
Practice Address - Country:US
Practice Address - Phone:605-224-5355
Practice Address - Fax:605-224-4846
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM5831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7803450Medicaid