Healthcare Provider Details

I. General information

NPI: 1013485374
Provider Name (Legal Business Name): MONTGOMERY ORTHODONTIC SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5833 CARMICHAEL ROAD
MONTGOMERY AL
36117
US

IV. Provider business mailing address

5833 CARMICHAEL ROAD
MONTGOMERY AL
36117
US

V. Phone/Fax

Practice location:
  • Phone: 334-260-8166
  • Fax: 334-260-8321
Mailing address:
  • Phone: 334-260-8166
  • Fax: 334-260-8321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL BRETT WOOD
Title or Position: ORTHODONTIST
Credential: DMD
Phone: 334-874-6627