Individual
TATE MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3824 S BOULEVARD STE 110, EDMOND, OK 73013-5779
(918) 200-9610
(913) 904-1353
Mailing address
PO BOX 30, SAPULPA, OK 74067-0030
(918) 200-9610
(913) 904-1353
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
58243
CA
122300000X
Dentist
60643
KS
122300000X
Dentist
6231
OK
1223D0004X
Dental Anesthesiology
Primary
6231
OK
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/29/2009
Last updated
04/02/2015
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