Healthcare Provider Details

I. General information

NPI: 1598846768
Provider Name (Legal Business Name): VINCENT MONTGOMERY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3727 NW 63RD ST SUITE 300
OKLAHOMA CITY OK
73116-1931
US

IV. Provider business mailing address

3727 NW 63RD ST SUITE 300
OKLAHOMA CITY OK
73116-1931
US

V. Phone/Fax

Practice location:
  • Phone: 405-292-2390
  • Fax: 405-292-2393
Mailing address:
  • Phone: 405-848-7994
  • Fax: 405-879-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number118
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: