Provider Demographics
NPI:1962848226
Name:MONTGOMERY COUNTY PERIODONTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY PERIODONTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:BA,DDS,MS
Authorized Official - Phone:281-363-2009
Mailing Address - Street 1:601 RIVER POINTE DR
Mailing Address - Street 2:STE 110
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2945
Mailing Address - Country:US
Mailing Address - Phone:281-363-2009
Mailing Address - Fax:281-367-5622
Practice Address - Street 1:601 RIVER POINTE DR
Practice Address - Street 2:STE 110
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2945
Practice Address - Country:US
Practice Address - Phone:281-363-2009
Practice Address - Fax:281-367-5622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty