Provider Demographics
NPI:1487363511
Name:MONTANO, DAISY (DDS)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:MONTANO
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 1:3636 FM 68
Mailing Address - Street 2:
Mailing Address - City:WOLFE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75496-4822
Mailing Address - Country:US
Mailing Address - Phone:903-486-4502
Mailing Address - Fax:
Practice Address - Street 1:1320 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-4245
Practice Address - Country:US
Practice Address - Phone:281-532-8183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-17
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX391581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice