Provider Demographics
NPI:1326048133
Name:MONTGOMERY, RICHARD FRANK JR (DDS MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:FRANK
Last Name:MONTGOMERY
Suffix:JR
Gender:M
Credentials:DDS MD
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Mailing Address - Street 1:501 JEFFERSON ST
Mailing Address - Street 2:STE 2
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028
Mailing Address - Country:US
Mailing Address - Phone:830-895-3494
Mailing Address - Fax:830-896-3390
Practice Address - Street 1:501 JEFFERSON ST
Practice Address - Street 2:STE 2
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-895-3494
Practice Address - Fax:830-896-3390
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX104781223S0112X
TXG5821207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C19490Medicare UPIN
TX00866EMedicare ID - Type Unspecified