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General NPI Number Information
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NPI Number | 1396090791
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Entity Type | Organization
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Legal Business Name | TATE MONTGOMERY DDS PLC
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Dates
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Enumeration Date | 07/22/2012
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Last Update Date | 07/22/2012
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Provider Practice Location Address
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Address Line | 911 N RIDGEWAY ST
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City | SAPULPA
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State | OK
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Zip | 74066-2417
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Country | US
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Telephone | 918-200-9610
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Fax | 918-200-9610
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Provider Business Mailing Address
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Address Line | 911 N RIDGEWAY ST
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City | SAPULPA
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State | OK
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Zip | 74066-2417
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Country | US
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Telephone | 918-200-9610
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Fax | 918-200-9610
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Authorized Official
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Title or Position | OWNER
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Name | DR. TATE MONTGOMERY
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Credential | DDS
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Telephone | 918-200-9610
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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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