Provider Demographics
NPI:1114133733
Name:ABBOTT, DAVID MONTGOMERY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MONTGOMERY
Last Name:ABBOTT
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 1:108 WAKEMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3662
Mailing Address - Country:US
Mailing Address - Phone:630-668-5251
Mailing Address - Fax:630-668-5485
Practice Address - Street 1:108 WAKEMAN AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3662
Practice Address - Country:US
Practice Address - Phone:630-668-5251
Practice Address - Fax:630-668-5485
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19016333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist