Healthcare Provider Details

I. General information

NPI: 1962603167
Provider Name (Legal Business Name): JOHN PAUL MONTGOMERY DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 LOUETTA RD
SPRING TX
77388-4731
US

IV. Provider business mailing address

1811 LOUETTA RD
SPRING TX
77388-4731
US

V. Phone/Fax

Practice location:
  • Phone: 281-350-1600
  • Fax: 281-350-4562
Mailing address:
  • Phone: 281-350-1600
  • Fax: 281-350-4562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN P MONTGOMERY
Title or Position: PRESIDENT
Credential: DDS
Phone: 281-350-1600