Provider Demographics
NPI:1801009469
Name:MONTGOMERY, REBECCA EATON (DDS)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:EATON
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:REBECCA
Other - Middle Name:GALE
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1501 E WOODFIELD RD
Mailing Address - Street 2:SUITE 100E
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-6052
Mailing Address - Country:US
Mailing Address - Phone:847-517-2800
Mailing Address - Fax:847-517-8770
Practice Address - Street 1:1501 E WOODFIELD RD
Practice Address - Street 2:SUITE 100E
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-6052
Practice Address - Country:US
Practice Address - Phone:847-517-2800
Practice Address - Fax:847-517-8770
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19027067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist