Provider Demographics
NPI:1528072717
Name:MONTEITH, MICHELE RENE' (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:RENE'
Last Name:MONTEITH
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 1:2420 RAVINE WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7650
Mailing Address - Country:US
Mailing Address - Phone:847-998-8990
Mailing Address - Fax:847-832-9309
Practice Address - Street 1:2420 RAVINE WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-7650
Practice Address - Country:US
Practice Address - Phone:847-998-8990
Practice Address - Fax:847-832-9309
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0244251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice