Provider Demographics
NPI:1295032944
Name:LEMBO MONTGOMERY DDS PA
Entity Type:Organization
Organization Name:LEMBO MONTGOMERY DDS PA
Other - Org Name:LEMBO MONTGOMERY COSMETIC AND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:SCHERER
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-660-1120
Mailing Address - Street 1:438 WILLIAMSON RD STE D
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9224
Mailing Address - Country:US
Mailing Address - Phone:704-660-1120
Mailing Address - Fax:704-660-1090
Practice Address - Street 1:438 WILLIAMSON RD STE D
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9224
Practice Address - Country:US
Practice Address - Phone:704-660-1120
Practice Address - Fax:704-660-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87011223G0001X
NC87291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty