Provider Demographics
NPI:1164494001
Name:MONTAG, THOMAS F (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:MONTAG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6513 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SIGEL
Mailing Address - State:PA
Mailing Address - Zip Code:15860-8715
Mailing Address - Country:US
Mailing Address - Phone:814-752-6068
Mailing Address - Fax:814-849-3309
Practice Address - Street 1:389 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1214
Practice Address - Country:US
Practice Address - Phone:814-849-3300
Practice Address - Fax:814-849-3309
Is Sole Proprietor?:No
Enumeration Date:2006-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029845L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice