Individual provider Active NPI

Shelly Elaine Montes, D.D.S

  • Periodontics
  • Cumming, GA
National Provider Identifier
1255340303
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PeriodonticsTaxonomy code 1223P0300X
License
10503 Issued in GA
Practice address
520 Pirkle Ferry Rd.
Suite B
Cumming, GA 30040
Phone
(770) 781-3685
Fax
(770) 781-9558
NPI assigned
Aug 7, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Periodontics 1223P0300X 10503 GA Primary

Addresses

Primary practice location

520 Pirkle Ferry Rd.
Suite B
Cumming, GA 30040

Mailing address

520 Pirkle Ferry Rd
Suite B
Cumming, GA 30040-9238
Phone (770) 781-3685

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180731000786 GA Order and Referring Only - DentistPractitioner - Oral SurgeryPractitioner - Dentist 0143578625

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10503GAMDPeriodontist

NPI Registry JSON

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255340303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 PIRKLE FERRY RD",
            "address_2": "SUITE B",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300409238",
            "telephone_number": "770-781-3685",
            "fax_number": "770-781-9558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 PIRKLE FERRY RD.",
            "address_2": "SUITE B",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "30040",
            "telephone_number": "770-781-3685",
            "fax_number": "770-781-9558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTES",
        "first_name": "SHELLY",
        "middle_name": "ELAINE",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "GA",
            "license": "10503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cumming, GA

Sources for this page

Verify at the official NPI Registry.