Provider Demographics
NPI:1760651731
Name:MONTGOMERY, AIMEE LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:LYNN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27852 SOLITUDE AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-7102
Mailing Address - Country:US
Mailing Address - Phone:951-323-4102
Mailing Address - Fax:951-602-6045
Practice Address - Street 1:11092 ANDERSON ST
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-7679
Practice Address - Country:US
Practice Address - Phone:909-558-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567021223D0004X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No122300000XDental ProvidersDentist