Provider Demographics
NPI:1700929452
Name:MONTGOMERY, DAVID JOHN (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:795 E MARSHALL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-4400
Mailing Address - Country:US
Mailing Address - Phone:610-431-0600
Mailing Address - Fax:610-701-0176
Practice Address - Street 1:795 E MARSHALL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4400
Practice Address - Country:US
Practice Address - Phone:610-431-0600
Practice Address - Fax:610-701-0176
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029329L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist