Provider Demographics
NPI:1437378841
Name:DRS. MONTGOMERY & KIRIAK, APC
Entity Type:Organization
Organization Name:DRS. MONTGOMERY & KIRIAK, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-347-0807
Mailing Address - Street 1:26800 CROWN VALLEY PARKWAY
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-347-0807
Mailing Address - Fax:949-347-8458
Practice Address - Street 1:26800 CROWN VALLEY PARKWAY
Practice Address - Street 2:SUITE 405
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-347-0807
Practice Address - Fax:949-347-8458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39169122300000X
CA41116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty