Provider Demographics
NPI:1376996512
Name:MONTGOMERY DENTAL ARTS LLC
Entity Type:Organization
Organization Name:MONTGOMERY DENTAL ARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHAMBURGER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:334-356-0228
Mailing Address - Street 1:10650 CHANTILLY PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7582
Mailing Address - Country:US
Mailing Address - Phone:334-356-0228
Mailing Address - Fax:334-356-0264
Practice Address - Street 1:10650 CHANTILLY PARKWAY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117
Practice Address - Country:US
Practice Address - Phone:334-398-2907
Practice Address - Fax:678-840-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty