Provider Demographics
NPI:1952461535
Name:MONTGOMERY, JEFFREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
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 1:116 RAVINE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:GATE CITY
Mailing Address - State:VA
Mailing Address - Zip Code:24251-3312
Mailing Address - Country:US
Mailing Address - Phone:276-386-6162
Mailing Address - Fax:276-386-2725
Practice Address - Street 1:116 RAVINE ST STE 100-201
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3311
Practice Address - Country:US
Practice Address - Phone:276-386-6162
Practice Address - Fax:276-386-2725
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014112281223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice