Active NPI
Tate Montgomery, DDS
- Dental Anesthesiology
- Edmond, OK
National Provider Identifier
1255575502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Anesthesiology
- License
- 6231
- Practice address
- 3824 S Boulevard Ste 110
Edmond, OK 73013-5779 - Phone
- (918) 200-9610
- Fax
- (913) 904-1353
- NPI assigned
- Apr 29, 2009
- Last updated
- Apr 2, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6231 | OK | |
| Dentist | 122300000X | 58243 | CA | |
| Dentist | 122300000X | 60643 | KS | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dental Anesthesiology | 1223D0004X | 6231 | OK | Primary |
Addresses
Primary practice location
3824 S Boulevard Ste 110
Edmond, OK 73013-5779
Mailing address
PO Box 30
Sapulpa, OK 74067-0030
Phone (918) 200-9610
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 60643 | KS | MD | Dentist |
| 6231 | OK | MD | Orthopedic Physical Therapist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1427932800000",
"number": "1255575502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 30",
"city": "SAPULPA",
"state": "OK",
"postal_code": "740670030",
"telephone_number": "918-200-9610",
"fax_number": "913-904-1353"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3824 S BOULEVARD STE 110",
"city": "EDMOND",
"state": "OK",
"postal_code": "730135779",
"telephone_number": "918-200-9610",
"fax_number": "913-904-1353"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MONTGOMERY",
"first_name": "TATE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-29",
"last_updated": "2015-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OK",
"license": "6231",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "58243",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KS",
"license": "60643",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "1223D0004X",
"taxonomy_group": "",
"desc": "Dentist, Dental Anesthesiology",
"state": "OK",
"license": "6231",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Edmond, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.