Active NPI
Mario Montanez, DDS
- Dentist
- Colorado Springs, CO
National Provider Identifier
1295767382
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8039
- Practice address
- 2436 S Academy Blvd
Colorado Springs, CO 80916-2408 - Phone
- (719) 391-2336
- Fax
- (719) 391-1625
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8039 | CO | Primary |
| Dentist | 122300000X | DD2106 | NM |
Addresses
Primary practice location
2436 S Academy Blvd
Colorado Springs, CO 80916-2408
Mailing address
1014 W 11TH St
La Junta, CO 81050-2659
Phone (719) 384-4614
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1624385 | Other | CO | UNITED CONCORDIA PROVIDER |
| 33079072 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DD2106 | NM | MD | Dentist |
| 8039 | CO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1295767382",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1014 W 11TH ST",
"city": "LA JUNTA",
"state": "CO",
"postal_code": "810502659",
"telephone_number": "719-384-4614",
"fax_number": "719-391-1625"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2436 S ACADEMY BLVD",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809162408",
"telephone_number": "719-391-2336",
"fax_number": "719-391-1625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTANEZ",
"first_name": "MARIO",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "8039",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "DD2106",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA PROVIDER",
"identifier": "1624385",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33079072",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.