Provider Demographics
NPI:1003843426
Name:MONTELEONE, KEVIN LOUIS (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LOUIS
Last Name:MONTELEONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 W ESTRELLA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5745
Mailing Address - Country:US
Mailing Address - Phone:813-250-9440
Mailing Address - Fax:813-250-9442
Practice Address - Street 1:4014 W ESTRELLA ST
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5745
Practice Address - Country:US
Practice Address - Phone:813-250-9440
Practice Address - Fax:813-250-9442
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00148981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery