Active NPI
John Montgomery, DDS
- Dentist
- Montgomery, TX
National Provider Identifier
1255441002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13113
- Practice address
- 18924 Freeport Drive
Suite a
Montgomery, TX 77356 - Phone
- (936) 582-4396
- Fax
- (936) 582-4311
- NPI assigned
- Aug 30, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 13113 | TX | Primary |
Addresses
Primary practice location
18924 Freeport Drive
Suite a
Montgomery, TX 77356
Mailing address
18924 Freeport Drive
Suite a
Montgomery, TX 77356
Phone (936) 582-4396
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 84D226 | Other | SD | BLUE CROSS BLUE SHIELD OF |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161024002289 | TX | Order and Referring Only - Dentist | 0547548612 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13113 | TX | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255441002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18924 FREEPORT DRIVE",
"address_2": "SUITE A",
"city": "MONTGOMERY",
"state": "TX",
"postal_code": "77356",
"telephone_number": "936-582-4396",
"fax_number": "936-582-4311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18924 FREEPORT DRIVE",
"address_2": "SUITE A",
"city": "MONTGOMERY",
"state": "TX",
"postal_code": "77356",
"telephone_number": "936-582-4396",
"fax_number": "936-582-4311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "JOHN",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "13113",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD OF",
"identifier": "84D226",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Montgomery, TX
- Montgomery Physical Therapy, PLLC
- Montgomery Rapidcare ER LLC (Rapidcare Emergency Room)
- Montgomery Sleep Diagnostic Center, LLC
- Montgomery Speech Therapy PLLC (Play Pediatric Therapy)
- Montgomery Wellness PLLC
- Matthew Montgomery
- Mika M'Laine Moore, APRN
- Peyton Michelle Morgan, M.S. SLP
- Murillo MHT LLC
- Murray Fershtman M.D. P.a. (Lake Area Pediatrics)
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.