Healthcare Provider Details

I. General information

NPI: 1780526996
Provider Name (Legal Business Name): JEREMY MONTROSE DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 W 21ST ST RM 308
NEW YORK NY
10010-7370
US

IV. Provider business mailing address

54 W 21ST ST RM 308
NEW YORK NY
10010-7370
US

V. Phone/Fax

Practice location:
  • Phone: 332-242-7332
  • Fax:
Mailing address:
  • Phone: 332-242-7332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JEREMY MONTROSE
Title or Position: DENTIST
Credential: DMD
Phone: 332-242-7332