Provider Demographics
NPI:1417632357
Name:MONTGOMERY, TREVOR S (DMD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:S
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 W CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019-2707
Mailing Address - Country:US
Mailing Address - Phone:602-427-4070
Mailing Address - Fax:602-427-4063
Practice Address - Street 1:3540 W CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-2707
Practice Address - Country:US
Practice Address - Phone:602-427-4070
Practice Address - Fax:602-427-4063
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0118601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice