Provider Demographics
NPI:1215619838
Name:MONTGOMERY, LAKEISHA
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 5210 BOX 230
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461-5210
Mailing Address - Country:US
Mailing Address - Phone:314-226-8317
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 944
Practice Address - Street 2:CHESTER ST.
Practice Address - City:LAKENHEATH
Practice Address - State:BRANDON
Practice Address - Zip Code:IP27 9PS
Practice Address - Country:GB
Practice Address - Phone:314-226-8317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant