MEDICARE: RONALD MONTGOMERY DENTAL GROUP, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1396787909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD MONTGOMERY DENTAL GROUP, PC

Provider Business Mailing Address
First Line	:	PO BOX 872710
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98687-2710
Country	:	US
Telephone Number	:	360-869-7645
Fax Number	:	877-725-7443

Provider Business Practice Location Address
First Line	:	6401 NW EXPRESSWAY
Second Line	:	SUITE 100
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73132-5170
Country	:	US
Telephone Number	:	405-721-7442
Fax Number	:	405-722-2841

Authorized Official
Title or Position	:	PC OWNER
Name	:	RONALD K MONTGOMERY
Credential	:	DDS
Telephone Number	:	405-698-1003

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	08/22/2025

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