# MICHAEL MONTGOMEY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134648249
- **Authorized official:** MICHAEL MONTGOMERY DDS (OWNER)
- **Authorized official phone:** (310) 821-0992

## Contact information

- **Practice address:** 8055 W MANCHESTER AVE STE 500, PLAYA DEL REY, CA 90293-7965
- **Practice address phone:** (310) 821-0992
- **Practice address fax:** (310) 821-9027
- **Mailing address:** 8055 W MANCHESTER AVE STE 500, PLAYA DEL REY, CA 90293-7965
- **Mailing address phone:** (310) 821-0992
- **Mailing address fax:** (310) 821-9027

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 29383 | CA | Yes |
| 261QD0000X | Dental Clinic/Center | 29383 | CA | — |

## Other

- **Enumeration date:** 09/11/2017
- **Last updated:** 07/21/2022