Provider Demographics
NPI:1174778435
Name:MONTGOMERY, LAWRENCE PURVES III (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:PURVES
Last Name:MONTGOMERY
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3797 SUMMIT LN
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3497
Mailing Address - Country:US
Mailing Address - Phone:215-920-2723
Mailing Address - Fax:215-822-5214
Practice Address - Street 1:3401 MARKET ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3318
Practice Address - Country:US
Practice Address - Phone:215-573-8400
Practice Address - Fax:215-573-5550
Is Sole Proprietor?:No
Enumeration Date:2008-11-28
Last Update Date:2008-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-023070-L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist