MEDICARE: DR. MICHAEL CHRISTOPHER MONTGOMERY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	29383	CA

General Provider Information

NPI Number	:	1235126533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL CHRISTOPHER MONTGOMERY DDS

Provider Business Mailing Address
First Line	:	8055 W MANCHESTER AVE
Second Line	:	SUITE 500
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7965
Country	:	US
Telephone Number	:	310-821-0992
Fax Number	:	310-821-9027

Provider Business Practice Location Address
First Line	:	8055 W MANCHESTER AVE
Second Line	:	SUITE 500
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7960
Country	:	US
Telephone Number	:	310-821-0992
Fax Number	:	310-821-9027

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2005
Last Update Date	:	02/15/2011

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