Edmund Warren Montgomery III, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1760-77 Issued in MS

Practice address

1921 Spillway Rd
Brandon, MS 39047-6021

Phone

(601) 992-9379

Fax

(601) 992-9393

NPI assigned

Mar 1, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174651103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 SPILLWAY RD",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390476021",
            "telephone_number": "601-992-9379",
            "fax_number": "601-992-9393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 SPILLWAY RD",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390476021",
            "telephone_number": "601-992-9379",
            "fax_number": "601-992-9393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "EDMUND",
        "middle_name": "WARREN",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "1760-77",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mobile Health Solutions Inc
• Frances H Mobley, LCSW
• Malori Michelle Molaison, BA
• Melissa Monaghan, M.A., CCC-SLP
• Christina Louise Montgomery
• Mooneyham Properties (4 the Family Healthcare)
• Jennifer Wedgeworth Mooneyham, FNP-BC
• Dorothy Ann Moore
• Dylan Moore
• Hannah Farris Moore, DPT

• General Practice Dentistry in Brandon, MS
• Providers in Brandon, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.