Jenna Simonne Montminy, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

11048 Issued in NC

Practice address

9920 Couloak Dr
#100
Charlotte, NC 28216

Phone

(704) 608-7897

NPI assigned

Apr 2, 2018

Last updated

Jul 3, 2019By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1522627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562112000000",
    "number": "1811493588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9920 COULOAK DR",
            "address_2": "#100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28216",
            "telephone_number": "704-355-8856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9920 COULOAK DR",
            "address_2": "#100",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28216",
            "telephone_number": "704-608-7897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTMINY",
        "first_name": "JENNA",
        "middle_name": "SIMONNE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-02",
        "last_updated": "2019-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "82194001",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "11048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monique M Montgomery, LCSW, LCDP
• Samuel Montgomery
• Tchernavia Ranesfore Montgomery, MSW, LCSW
• Thomas Montgomery, MD
• Tia Michele Montiero
• Lucille Pauline Montminy, FNP-C
• Michelle Montoya-Pedroza
• Nancy Colette Montz, MD
• Kristin Hayes Monza, NP
• Javad Monzavifar, MD

• Dentist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Dentist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; 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.

Verify at the official NPI Registry.