Healthcare Provider Details

I. General information

NPI: 1760651731
Provider Name (Legal Business Name): AIMEE LYNN MONTGOMERY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11092 ANDERSON ST
LOMA LINDA CA
92350-7679
US

IV. Provider business mailing address

27852 SOLITUDE AVE
MORENO VALLEY CA
92555-7102
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4611
  • Fax:
Mailing address:
  • Phone: 951-323-4102
  • Fax: 951-602-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number56702
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number56702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: