Provider Demographics
NPI:1104442631
Name:MONTOYA, SAMANTHA ANN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:ANN
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 BUSINESS CENTER DR STE 2
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-9027
Mailing Address - Country:US
Mailing Address - Phone:904-215-0980
Mailing Address - Fax:
Practice Address - Street 1:1530 BUSINESS CENTER DR STE 2
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-9027
Practice Address - Country:US
Practice Address - Phone:904-215-0980
Practice Address - Fax:904-215-0952
Is Sole Proprietor?:No
Enumeration Date:2020-06-20
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.032678122300000X
FLDN25697122300000X, 1223X0400X
NC11809122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1225677925OtherCLINIC/CENTER - DENTAL