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General NPI Number Information
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NPI Number | 1376996512
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Entity Type | Organization
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Legal Business Name | MONTGOMERY DENTAL ARTS LLC
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 10650 CHANTILLY PARKWAY
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City | MONTGOMERY
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State | AL
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Zip | 36117
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Country | US
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Telephone | 334-398-2907
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Fax | 678-840-3982
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Provider Business Mailing Address
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Address Line | 10650 CHANTILLY PKWY
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City | MONTGOMERY
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State | AL
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Zip | 36117-7582
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Country | US
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Telephone | 334-356-0228
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Fax | 334-356-0264
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Authorized Official
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Title or Position | MBR
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Name | DR. DOMINIQUE A SHAMBURGER JR.
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Credential | DDS
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Telephone | 334-356-0228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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