MEDICARE: MONTGOMERY DENTAL CENTER PLLC

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	:	1497624472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY DENTAL CENTER PLLC

Provider Business Mailing Address
First Line	:	2109 COMMERCE ST STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-4350
Country	:	US
Telephone Number	:	972-248-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	951 LONE STAR PKWY
Second Line	:
City	:	MONTGOMERY
State	:	TX
Zip	:	77356-7717
Country	:	US
Telephone Number	:	936-241-9506
Fax Number	:

Authorized Official
Title or Position	:	OWNER, DENTIST
Name	:	WILLIAM ROBERT JENNINGS
Credential	:	DDS
Telephone Number	:	940-206-8959

Provider Enumeration Date	:	10/30/2025
Last Update Date	:	10/30/2025

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