Montgomery, Charles Robert

Montgomery, Charles Robert is an sole proprietor health care provider with primary practice located at 302 Mackenzie Dr , Jackson NJ 08527-1184. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Montgomery, Charles Robert can be contacted via phone (732) 901-9036.

Contact Information

Primary practice address
302 Mackenzie Dr Jackson NJ 08527-1184
Phone: (732) 901-9036
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X DI01679400 New Jersey

Profile Details

NPI number 1720148745
LBN Legal business name Montgomery, Charles Robert
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 11th, 2006
Last updated Sep 17th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720148745 NPPES
New Jersey MEDICAID 1263706

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