Provider Demographics
NPI:1598846768
Name:MONTGOMERY, VINCENT (DDS)
Entity Type:Individual
Prefix:
First Name:VINCENT
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 1:3727 NW 63RD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1931
Mailing Address - Country:US
Mailing Address - Phone:405-848-7994
Mailing Address - Fax:405-879-6334
Practice Address - Street 1:3727 NW 63RD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1931
Practice Address - Country:US
Practice Address - Phone:405-292-2390
Practice Address - Fax:405-292-2393
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU57546Medicare UPIN