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General NPI Number Information
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NPI Number | 1225333578
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Entity Type | Organization
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Legal Business Name | KATHRYN K MONTGOMERY DDS LLC
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 15580 US RT 36E
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City | MARYSVILLE
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State | OH
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Zip | 43040
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Country | US
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Telephone | 937-642-1151
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Fax |
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Provider Business Mailing Address
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Address Line | 15580 US RT 36E
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City | MARYSVILLE
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State | OH
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Zip | 43040
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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 | OWNER
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Name | MRS. KATHRYN K MONTGOMERY
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Credential | DDS
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Telephone | 937-642-1151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30022373
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License Number State | OH
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