Provider Demographics
NPI:1881150688
Name:MONTANARO, NICHOLAS JOHN (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JOHN
Last Name:MONTANARO
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:207 HALLOCK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-3072
Mailing Address - Country:US
Mailing Address - Phone:631-675-9601
Mailing Address - Fax:631-675-9602
Practice Address - Street 1:207 HALLOCK RD STE 2
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-3072
Practice Address - Country:US
Practice Address - Phone:631-675-9601
Practice Address - Fax:631-675-9602
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY338189204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty