Provider Demographics
NPI:1639588155
Name:MONTGOMERY PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:MONTGOMERY PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-454-3722
Mailing Address - Street 1:211 COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1508
Mailing Address - Country:US
Mailing Address - Phone:609-454-3722
Mailing Address - Fax:
Practice Address - Street 1:211 COMMONS WAY
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1508
Practice Address - Country:US
Practice Address - Phone:609-454-3722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02459900261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental