Provider Demographics
NPI:1750897955
Name:DR. MONTGOMERY ORTHODONTICS INC
Entity type:Organization
Organization Name:DR. MONTGOMERY ORTHODONTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-467-3446
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:MILLERSPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43046-0640
Mailing Address - Country:US
Mailing Address - Phone:740-467-3446
Mailing Address - Fax:740-467-0984
Practice Address - Street 1:11985 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:MILLERSPORT
Practice Address - State:OH
Practice Address - Zip Code:43046-0640
Practice Address - Country:US
Practice Address - Phone:740-467-3446
Practice Address - Fax:740-467-0984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty