Provider Demographics
NPI:1750515235
Name:MONTROSE, JEREMY (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:MONTROSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JEREMY
Other - Middle Name:
Other - Last Name:MONTROSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:929 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1559
Mailing Address - Country:US
Mailing Address - Phone:847-675-6767
Mailing Address - Fax:
Practice Address - Street 1:929 RIDGE RD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1559
Practice Address - Country:US
Practice Address - Phone:847-675-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist