Provider Demographics
NPI:1972300945
Name:MONTOYA, HOLLY ANN (RDH)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:ANN
Last Name:MONTOYA
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:ANN
Other - Last Name:TRUJILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 467
Mailing Address - Street 2:
Mailing Address - City:ZUNI
Mailing Address - State:NM
Mailing Address - Zip Code:87327-0467
Mailing Address - Country:US
Mailing Address - Phone:505-782-7349
Mailing Address - Fax:
Practice Address - Street 1:ROUTE 301 NORTH 21 B AVENUE
Practice Address - Street 2:
Practice Address - City:ZUNI PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87327
Practice Address - Country:US
Practice Address - Phone:505-782-7349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH2520124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist