Provider Demographics
NPI:1366750614
Name:MONTALVO, REBECCA JUDITH (DDS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JUDITH
Last Name:MONTALVO
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 1:5425 POLK ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023-1444
Mailing Address - Country:US
Mailing Address - Phone:713-767-3401
Mailing Address - Fax:713-767-3408
Practice Address - Street 1:5425 POLK ST
Practice Address - Street 2:SUITE J
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-1444
Practice Address - Country:US
Practice Address - Phone:713-767-3401
Practice Address - Fax:713-767-3408
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-21
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0025517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist