Healthcare Provider Details

I. General information

NPI: 1528087715
Provider Name (Legal Business Name): MONTGOMERY ORTHODONTICS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 TAMARACK CIR
SKILLMAN NJ
08558-2019
US

IV. Provider business mailing address

83 TAMARACK CIR
SKILLMAN NJ
08558-2019
US

V. Phone/Fax

Practice location:
  • Phone: 609-688-1611
  • Fax: 609-688-8309
Mailing address:
  • Phone: 609-688-1611
  • Fax: 609-688-8309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDI19889
License Number StateNJ

VIII. Authorized Official

Name: DR. MARY ANNE RICHMOND
Title or Position: PRESIDENT/CEO
Credential: D.M.D., M.S.
Phone: 609-688-1611