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General NPI Number Information
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NPI Number | 1255575502
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Entity Type | Individual
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Provider Name | TATE MONTGOMERY DDS
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Gender | Male
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 3824 S BOULEVARD STE 110
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City | EDMOND
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State | OK
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Zip | 73013-5779
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Country | US
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Telephone | 918-200-9610
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Fax | 913-904-1353
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Provider Business Mailing Address
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Address Line | PO BOX 30
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City | SAPULPA
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State | OK
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Zip | 74067-0030
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Country | US
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Telephone | 918-200-9610
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Fax | 913-904-1353
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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 | 6231
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 58243
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60643
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number | 6231
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License Number State | OK
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