Individual
DR. CHARLES ERNEST MONTAGUE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1330 CENTRAL AVENUE, ASHLAND, KY 41101
(606) 329-0919
Mailing address
1330 CENTRAL AVENUE, ASHLAND, KY 41101
(606) 329-0919
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5224
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60052248
—
KY
01
—
YA20
DELTA DENTAL
—
Enumeration date
02/09/2007
Last updated
07/08/2007
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