Organization
MICHAEL C. MONTGOMERY D.M.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL CLINTON MONTGOMER D.M.D. (OWNER OPERATOR)
(706) 342-1242
Entity
Organization
Contact information
Practice address
1040 BARCLAY DR, MADISON, GA 30650-4621
(706) 342-1242
Mailing address
1040 BARCLAY DR, MADISON, GA 30650-4621
(706) 342-1242
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN010347
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00351843A
—
GA
05
—
100805
—
GA
05
—
9183572
—
GA
Enumeration date
01/25/2007
Last updated
08/22/2020
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