Provider Demographics
NPI:1306840384
Name:MONTAG, BARRY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:M
Last Name:MONTAG
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 1:294 S UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3308
Mailing Address - Country:US
Mailing Address - Phone:954-475-8000
Mailing Address - Fax:954-370-9163
Practice Address - Street 1:294 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3308
Practice Address - Country:US
Practice Address - Phone:954-475-8000
Practice Address - Fax:954-370-9163
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice