Montgomery, Andrea M

Montgomery, Andrea M is an individual health care provider with primary practice located at 725 Nw 67Th St , Lawton OK 73505-4202. She recently has only one registered license in Dental Providers / General Practice, which is considered as her primary health care specialty. Montgomery, Andrea M can be contacted via phone (580) 536-3313.

Contact Information

Primary practice address
725 Nw 67Th St Lawton OK 73505-4202
Phone: (580) 536-3313
Fax: (580) 536-2011
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 5721 Oklahoma

Profile Details

NPI number 1508860933
LBN Legal business name Montgomery, Andrea M
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2005
Last updated Sep 17th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508860933 NPPES
Oklahoma MEDICAID 200035620A

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