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General NPI Number Information
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NPI Number | 1205556917
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Entity Type | Individual
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Provider Name | DREW MONTGOMERY LDA
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Gender | Female
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Dates
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Enumeration Date | 09/01/2022
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Last Update Date | 09/01/2022
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Provider Practice Location Address
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Address Line | 7430 80TH ST S STE 202
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-3041
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Country | US
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Telephone | 651-459-6884
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Fax |
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Provider Business Mailing Address
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Address Line | 9820 78TH ST S
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City | COTTAGE GROVE
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State | MN
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Zip | 55016-5229
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number | A16764
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License Number State | MN
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