Provider Demographics
NPI:1417160136
Name:MONTGOMERY, HEATH MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:HEATH
Middle Name:MICHAEL
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 W VALERIO ST
Mailing Address - Street 2:STE C
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2553
Mailing Address - Country:US
Mailing Address - Phone:805-845-3240
Mailing Address - Fax:805-845-3244
Practice Address - Street 1:14 W VALERIO ST
Practice Address - Street 2:STE C
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2553
Practice Address - Country:US
Practice Address - Phone:805-845-3240
Practice Address - Fax:805-845-3244
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA524351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice