MEDICARE: T & S OMFS 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1811343718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T & S OMFS PLLC

Provider Business Mailing Address
First Line	:	505 E HUNTLAND DR STE 340
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78752-3745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 W 34TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-2008
Country	:	US
Telephone Number	:	512-206-2929
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. MARTY MONTGOMERY
Credential	:	DMD
Telephone Number	:	512-676-4444

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	05/10/2016

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