Provider Demographics
NPI:1588787139
Name:MONTGOMERY, NICOLE SIVIE (DDS)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SIVIE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:LEIGH
Other - Last Name:SIVIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5800 COIT RD.
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5944
Mailing Address - Country:US
Mailing Address - Phone:972-596-9697
Mailing Address - Fax:972-867-4796
Practice Address - Street 1:5800 COIT RD.
Practice Address - Street 2:SUITE 800
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5944
Practice Address - Country:US
Practice Address - Phone:972-596-9697
Practice Address - Fax:972-867-4796
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX902701OtherUNITED CONCORDIA
TX85D562OtherFEDERAL BLUE CROSS