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General NPI Number Information
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NPI Number | 1376674218
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Entity Type | Individual
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Provider Name | R. GREGORY MONTGOMERY DDS
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Gender | Male
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 120 LOCUST AVENUE EXTENTION
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City | MOUNT MORRIS
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State | PA
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Zip | 15349
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Country | US
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Telephone | 724-324-9001
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Fax |
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Provider Business Mailing Address
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Address Line | 120 LOCUST AVE EXT
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City | MOUNT MORRIS
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State | PA
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Zip | 15349-1355
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Country | US
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Telephone | 724-324-9001
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS-026391-L
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License Number State | PA
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