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General NPI Number Information
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NPI Number | 1184087785
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Entity Type | Organization
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Legal Business Name | MONTGOMERY FAMILY DENTAL, PLLC
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 110 1ST ST N
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City | MONTGOMERY
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State | MN
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Zip | 56069-1514
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Country | US
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Telephone | 507-364-8001
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Fax |
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Provider Business Mailing Address
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Address Line | 110 1ST ST N
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City | MONTGOMERY
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State | MN
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Zip | 56069-1514
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Country | US
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Telephone | 507-364-8001
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. SETH HUIRAS
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Credential | D.D.S.
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Telephone | 507-364-8001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D13630
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License Number State | MN
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