| Michael C. Montgomery D.m.d.,p.c. | |
|
1040 Barclay Dr Madison GA 30650-4621 | |
| (706) 342-1242 | |
| Not Available |
| Full Name | Michael C. Montgomery D.m.d.,p.c. |
|---|---|
| Speciality | Dentist |
| Location | 1040 Barclay Dr, Madison, Georgia |
| Authorized Official Name and Position | Michael Clinton Montgomer (OWNER OPERATOR) |
| Authorized Official Contact | 7063421242 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael C. Montgomery D.m.d.,p.c. 1040 Barclay Dr Madison GA 30650-4621 Ph: (706) 342-1242 | Michael C. Montgomery D.m.d.,p.c. 1040 Barclay Dr Madison GA 30650-4621 Ph: (706) 342-1242 |
| NPI Number | 1508911793 |
|---|---|
| Provider Enumeration Date | 01/25/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508911793 | NPI | - | NPPES |
| 00351843A | Medicaid | GA | |
| 100805 | Medicaid | GA | |
| 9183572 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN010347 (Georgia) | Primary |
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