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NPI Code Detail

MEDICARE: DR. THOMAS ANTHONY MONTAGNESE D.D.S.

MEDICARE: DR. THOMAS ANTHONY MONTAGNESE D.D.S.
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
11223E0200XEndodontics14901OH

General Provider Information

NPI Number : 1861497976
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS ANTHONY MONTAGNESE D.D.S.
Provider Business Mailing Address
First Line : 1550 COOPER FOSTER PARK RD W
Second Line :
City : LORAIN
State : OH
Zip : 44053-3616
Country : US
Telephone Number : 440-960-2660
Fax Number : 440-960-0180
Provider Business Practice Location Address
First Line : 1550 COOPER FOSTER PARK RD W
Second Line :
City : LORAIN
State : OH
Zip : 44053-3616
Country : US
Telephone Number : 440-960-2660
Fax Number : 440-960-0180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 11/28/2011

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