MEDICARE: MRS. NICOLE SIVIE 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	1223G0001X	General Practice Dentistry	19329	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	902701	OTHER	TX	UNITED CONCORDIA
2	85D562	OTHER	TX	FEDERAL BLUE CROSS

General Provider Information

NPI Number	:	1588787139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOLE SIVIE MONTGOMERY DDS

Provider Business Mailing Address
First Line	:	5800 COIT RD.
Second Line	:	SUITE 800
City	:	PLANO
State	:	TX
Zip	:	75023-5944
Country	:	US
Telephone Number	:	972-596-9697
Fax Number	:	972-867-4796

Provider Business Practice Location Address
First Line	:	5800 COIT RD.
Second Line	:	SUITE 800
City	:	PLANO
State	:	TX
Zip	:	75023-5944
Country	:	US
Telephone Number	:	972-596-9697
Fax Number	:	972-867-4796

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	12/11/2007

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Directions to “ MRS. NICOLE SIVIE MONTGOMERY DDS” Practice Location

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