MEDICARE: MONTGOMERY ORTHODONTICS, P.A.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DI19889	NJ

General Provider Information

NPI Number	:	1528087715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY ORTHODONTICS, P.A.

Provider Business Mailing Address
First Line	:	83 TAMARACK CIR
Second Line	:
City	:	SKILLMAN
State	:	NJ
Zip	:	08558-2019
Country	:	US
Telephone Number	:	609-688-1611
Fax Number	:	609-688-8309

Provider Business Practice Location Address
First Line	:	83 TAMARACK CIR
Second Line	:
City	:	SKILLMAN
State	:	NJ
Zip	:	08558-2019
Country	:	US
Telephone Number	:	609-688-1611
Fax Number	:	609-688-8309

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. MARY ANNE RICHMOND
Credential	:	D.M.D., M.S.
Telephone Number	:	609-688-1611

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	08/22/2020

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