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General NPI Number Information
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NPI Number | 1235126533
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Entity Type | Individual
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Provider Name | MICHAEL CHRISTOPHER MONTGOMERY DDS
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Gender | Male
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Dates
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Enumeration Date | 10/02/2005
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Last Update Date | 02/15/2011
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Provider Practice Location Address
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Address Line | 8055 W MANCHESTER AVE SUITE 500
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7960
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Country | US
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Telephone | 310-821-0992
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Fax | 310-821-9027
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Provider Business Mailing Address
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Address Line | 8055 W MANCHESTER AVE SUITE 500
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7965
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Country | US
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Telephone | 310-821-0992
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Fax | 310-821-9027
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 29383
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License Number State | CA
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