Provider Demographics
NPI:1942947551
Name:LD-MONTGOMERY, LLC
Entity Type:Organization
Organization Name:LD-MONTGOMERY, LLC
Other - Org Name:RIVER CITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAIGNEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:BA, MA
Authorized Official - Phone:256-783-9468
Mailing Address - Street 1:7022 VAUGHN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36116-1370
Mailing Address - Country:US
Mailing Address - Phone:334-271-3111
Mailing Address - Fax:334-271-3112
Practice Address - Street 1:7022 VAUGHN RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-1370
Practice Address - Country:US
Practice Address - Phone:334-271-3111
Practice Address - Fax:334-271-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental