Edward Montalbo, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

49378 Issued in CA

Practice address

11310 Prospect Dr Ste 30
Jackson, CA 95642-9369

Phone

(209) 267-9300

Fax

(209) 267-9309

NPI assigned

Feb 6, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735862400000",
    "number": "1508905670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11310 PROSPECT DR STE 30",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "956429369",
            "telephone_number": "209-267-9300",
            "fax_number": "209-267-9309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11310 PROSPECT DR STE 30",
            "city": "JACKSON",
            "state": "CA",
            "postal_code": "956429369",
            "telephone_number": "209-267-9300",
            "fax_number": "209-267-9309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTALBO",
        "first_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-06",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "49378",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Jackson, CA
• Providers in Jackson, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.