TATE MONTGOMERY (NPI# 1255575502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255575502 |
| Entity Type | Individual |
| Full Name | TATE MONTGOMERY |
| Credential | DDS |
| Practice Address |
3824 S Boulevard Ste 110 Edmond OK 73013-5779 |
| Mailing Address |
Po Box 30 Sapulpa OK 74067-0030 |
| Practice Telephone | 9182009610 |
| Practice Fax Number | 9139041353 |
| Mailing Telephone | 9182009610 |
| Mailing Fax Number | 9139041353 |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2015-04-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 122300000X | Dentist | 60643 | KS | Dental Providers |
| N | 122300000X | Dentist | 58243 | CA | Dental Providers |
| N | 122300000X | Dentist | 6231 | OK | Dental Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care | ||
| Y | 1223D0004X |
Dentist Specialization: Dentist Anesthesiologist |
6231 | OK | Dental Providers |
| Street Address |
3824 S BOULEVARD STE 110 |
| City | EDMOND |
| State | OK |
| Zip Code | 73013-5779 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407461866 | Alison Church-pugh | Case Manager/Care Coordinator | 1441 Kelley Pointe Pkwy, Edmond, OK 73013 | 2020-09-12 |
| 1699395343 | Dental Specialists of Edmond | Dentist | 16430 Muirfield Pl, Edmond, OK 73013 | 2020-04-23 |
| 1104477215 | Kammerer Richey LLC | Nurse Practitioner | 902 Nw 139th Street Parway, Edmond, OK 73013 | 2019-09-20 |
| 1811459191 | Peak Movement Centre, Pllc | Clinic/Center | 13816 Santa Fe Crossing Dr, Edmond, OK 73013 | 2019-04-04 |
| 1851858492 | Luma Hilal | Pharmacist | 2228 Nw 15th Terrace, Edmond, OK 73013 | 2019-03-01 |
| 1578031571 | Oklahoma Wellness Group LLC | Internal Medicine | 14101 North Esatern Avenue Suite B, Edmond, OK 73013 | 2018-11-07 |
| 1477034395 | Specialty Care Pediatrics, Inc. | Home Health | 2256 Nw 164th Street, Edmond, OK 73013 | 2018-08-28 |
| 1972083921 | Pooja Bhakta | Physician Assistant | Stanbro Healthcare Group LLC, 2000 E. 15th St., Suite 400-a, Edmond, OK 73013 | 2018-08-20 |
| 1417460577 | Oklahoma Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 15103 N Macarthur Blvd, Oklahoma City, OK 73013 | 2017-11-13 |
| 1356879753 | Shawn Smith Optimal Pt and Performance, Pllc | Physical Therapist | 336 Ne 145th Pl, Edmond, OK 73013 | 2017-05-30 |
| Find all providers in zip 73013 | ||||
| Taxonomy Code | 1223D0004X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Dentist Anesthesiologist |
| A dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation’s Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology. |
| Notes: Source: The American Society of Dentist Anesthesiologists [1/1/2013: new] |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.