Provider Demographics
NPI:1962650234
Name:NEWKIRK&MONTGOMERY,LLC
Entity Type:Organization
Organization Name:NEWKIRK&MONTGOMERY,LLC
Other - Org Name:SYNERGY DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-656-9331
Mailing Address - Street 1:22250 S SALAMO RD
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-7206
Mailing Address - Country:US
Mailing Address - Phone:503-656-9331
Mailing Address - Fax:503-656-9391
Practice Address - Street 1:22250 S SALAMO RD
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-7206
Practice Address - Country:US
Practice Address - Phone:503-656-9331
Practice Address - Fax:503-656-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5678261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental