Provider Demographics
NPI:1568136471
Name:MONTGOMERY, BRADEN CONRAD (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:CONRAD
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 1:95 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:PA
Mailing Address - Zip Code:15558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:95 GRANT ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:PA
Practice Address - Zip Code:15558
Practice Address - Country:US
Practice Address - Phone:814-662-2737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0432821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice