Provider Demographics
NPI:1497312458
Name:MONTGOMERY, CHELSEA ANN (EPDH)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 WINDEMERE DR NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-2721
Mailing Address - Country:US
Mailing Address - Phone:503-999-6213
Mailing Address - Fax:
Practice Address - Street 1:1251 LANCASTER DR NE STE A
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-1994
Practice Address - Country:US
Practice Address - Phone:503-391-2219
Practice Address - Fax:503-391-4239
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4992124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist