Healthcare Provider Details

I. General information

NPI: 1043995624
Provider Name (Legal Business Name): ANDREA JOY MONTGOMERY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 UNIVERSITY AVE
DES MOINES IA
50311-3339
US

IV. Provider business mailing address

4626 UNIVERSITY AVE
DES MOINES IA
50311-3339
US

V. Phone/Fax

Practice location:
  • Phone: 515-277-3766
  • Fax:
Mailing address:
  • Phone: 563-880-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-10132
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10132
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: