Provider Demographics
NPI:1699717371
Name:RONALD MONTGOMERY DENTAL GROUP, PC
Entity type:Organization
Organization Name:RONALD MONTGOMERY DENTAL GROUP, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-698-1003
Mailing Address - Street 1:1101 SE TECH CENTER DR STE 195
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-5511
Mailing Address - Country:US
Mailing Address - Phone:608-697-6453
Mailing Address - Fax:877-725-7443
Practice Address - Street 1:6002 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1602
Practice Address - Country:US
Practice Address - Phone:405-631-9100
Practice Address - Fax:405-631-4672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty