Provider Demographics
NPI:1396090791
Name:TATE MONTGOMERY DDS PLC
Entity type:Organization
Organization Name:TATE MONTGOMERY DDS PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TATE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-200-9610
Mailing Address - Street 1:911 N RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-2417
Mailing Address - Country:US
Mailing Address - Phone:918-200-9610
Mailing Address - Fax:918-200-9610
Practice Address - Street 1:911 N RIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-2417
Practice Address - Country:US
Practice Address - Phone:918-200-9610
Practice Address - Fax:918-200-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-22
Last Update Date:2012-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6231122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty