# BERKELEY ORAL AND MAXILLOFACIAL SURGERY PA

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

## Provider details

- **NPI number:** 1558486845
- **Authorized official:** DR. JAMES ALBERT MONTGOMERY JR. D.M.D. (ORAL SURGEON)
- **Authorized official phone:** (843) 825-4131

## Contact information

- **Practice address:** 111 SHELLY ST., BONNEAU, SC 29431-0280
- **Practice address phone:** (843) 825-4131
- **Practice address fax:** (843) 825-4136
- **Mailing address:** PO BOX 280, BONNEAU, SC 29431-0280
- **Mailing address phone:** (843) 825-4131
- **Mailing address fax:** (843) 825-4136

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 3180 | SC | Yes |

## Other

- **Enumeration date:** 03/19/2007
- **Last updated:** 08/22/2020