Provider Demographics
NPI:1497768444
Name:MONTGOMERY, ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
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 1:1127 S ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1408
Mailing Address - Country:US
Mailing Address - Phone:559-237-3390
Mailing Address - Fax:559-237-0400
Practice Address - Street 1:1127 S ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1408
Practice Address - Country:US
Practice Address - Phone:559-237-3390
Practice Address - Fax:559-237-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist