Provider Demographics
NPI:1063081115
Name:MONTAG, GRACE (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:MONTAG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:E
Other - Last Name:DICKERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4966
Mailing Address - Country:US
Mailing Address - Phone:402-379-2775
Mailing Address - Fax:
Practice Address - Street 1:513 S 13TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4966
Practice Address - Country:US
Practice Address - Phone:402-379-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE77251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice