Provider Demographics
NPI:1841450368
Name:MONTEJO, DANIA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIA
Middle Name:MARIE
Last Name:MONTEJO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 E MERRITT ISLAND CSWY
Mailing Address - Street 2:SUTIE 6C
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952
Mailing Address - Country:US
Mailing Address - Phone:321-633-7672
Mailing Address - Fax:321-256-5449
Practice Address - Street 1:780 E MERRITT ISLAND CSWY
Practice Address - Street 2:SUTIE 6C
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952
Practice Address - Country:US
Practice Address - Phone:321-633-7672
Practice Address - Fax:321-256-5449
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 114901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice