Provider Demographics
NPI:1255340303
Name:MONTES, SHELLY ELAINE (DDS)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:ELAINE
Last Name:MONTES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:520 PIRKLE FERRY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9238
Mailing Address - Country:US
Mailing Address - Phone:770-781-3685
Mailing Address - Fax:770-781-9558
Practice Address - Street 1:520 PIRKLE FERRY RD.
Practice Address - Street 2:SUITE B
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040
Practice Address - Country:US
Practice Address - Phone:770-781-3685
Practice Address - Fax:770-781-9558
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA105031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics