Individual
DR. ANDREA M MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
725 NW 67TH ST, LAWTON, OK 73505-4202
(580) 536-3313
(580) 536-2011
Mailing address
725 NW 67TH ST, LAWTON, OK 73505-4202
(580) 536-3313
(580) 536-2011
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5721
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200035620A
—
OK
Enumeration date
06/13/2005
Last updated
09/17/2012
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