Provider Demographics
NPI:1760583231
Name:ALAN B MONTGOMERY ORTHODONTICS
Entity Type:Organization
Organization Name:ALAN B MONTGOMERY ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:651-765-1945
Mailing Address - Street 1:4535 HODGSON RD
Mailing Address - Street 2:700
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126
Mailing Address - Country:US
Mailing Address - Phone:651-765-1945
Mailing Address - Fax:651-765-1949
Practice Address - Street 1:4535 HODGSON RD
Practice Address - Street 2:700
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126
Practice Address - Country:US
Practice Address - Phone:651-765-1945
Practice Address - Fax:651-765-1949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN85841223X0400X
UT14424999211223X0400X
AZD33271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty