Provider Demographics
NPI:1134284714
Name:RIDDLE MONTGOMERY METHENY DDS INC
Entity Type:Organization
Organization Name:RIDDLE MONTGOMERY METHENY DDS INC
Other - Org Name:FAMILY DENTAL PRACTICE INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST MANAGER SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-636-1100
Mailing Address - Street 1:108 THIRD ST
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-636-1100
Mailing Address - Fax:304-636-0066
Practice Address - Street 1:108 THIRD ST
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-1100
Practice Address - Fax:304-636-0066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV122300000X
WVW3576122300000X
WVWV2192122300000X
WVWV3367122300000X
WVWV2960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty