Provider Demographics
NPI:1376674218
Name:MONTGOMERY, R. GREGORY (DDS)
Entity Type:Individual
Prefix:DR
First Name:R.
Middle Name:GREGORY
Last Name:MONTGOMERY
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 1:120 LOCUST AVE EXT
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:PA
Mailing Address - Zip Code:15349-1355
Mailing Address - Country:US
Mailing Address - Phone:724-324-9001
Mailing Address - Fax:
Practice Address - Street 1:120 LOCUST AVENUE EXTENTION
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:PA
Practice Address - Zip Code:15349
Practice Address - Country:US
Practice Address - Phone:724-324-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-026391-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice