Provider Demographics
NPI:1699127209
Name:PHOEBE E. MONTEMAYOR, DDS, INC.
Entity type:Organization
Organization Name:PHOEBE E. MONTEMAYOR, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHOEBE-ELYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:MONTEMAYOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-814-3645
Mailing Address - Street 1:1850 GERANIUM WAY
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-6718
Mailing Address - Country:US
Mailing Address - Phone:209-814-3645
Mailing Address - Fax:
Practice Address - Street 1:20345 SANTA MARIA AVE
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4227
Practice Address - Country:US
Practice Address - Phone:510-537-5229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty