Organization
MONTGOMERY RADIOGRAPHIC SVS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MONTE MATTHEW MONTGOMERY XRAY TECHNICIAN (OWNER XRAY TECHNICIAN)
(714) 835-7260
Entity
Organization
Contact information
Practice address
720 N TUSTIN AVE STE 204, SANTA ANA, CA 92705-3606
(714) 835-7260
(714) 835-5808
Mailing address
720 N TUSTIN AVE 204, SANTA ANA, CA 92705
(714) 835-7260
(714) 835-5808
Taxonomy
Speciality
Code
Description
License number
State
1223X0008X
Oral and Maxillofacial Radiology Dentistry
Primary
RHP 52036
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CGP168497
PROVIDER NUMBER
CA
Enumeration date
05/09/2007
Last updated
08/22/2020
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