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Individual

ALAN B MONTGOMERY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.D.S, M.S.

Contact information

Practice address
4535 HODGSON RD, #700, SHOREVIEW, MN 55126-1949
(651) 765-1945
(651) 765-1949
Mailing address
4535 HODGSON RD, #700, SHOREVIEW, MN 55126-1949
(651) 765-1945
(651) 765-1949

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D8584
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
176058321
NPI ENUMERATOR, TYPE 2 NPI
MN
Enumeration date
12/16/2009
Last updated
12/16/2009
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