Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 58243 | CA |
N | 122300000X | Dentist | 60643 | KS |
N | 122300000X | Dentist | 6231 | OK |
Y | 1223D0004X | Dentist Anesthesiologist | 6231 | OK |
NPI | 1255575502 |
---|---|
Provider Name | Tate Montgomery |
First Address | Sapulpa, OK 74067-0030 |
Second Address | Edmond, OK 73013-5779 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2009 |
Last Update Date | 02/04/2015 |