Provider Demographics
NPI:1487710794
Name:GARY V. MONTEITH DDS PA
Entity type:Organization
Organization Name:GARY V. MONTEITH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTEITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-983-4565
Mailing Address - Street 1:PO BOX 1047
Mailing Address - Street 2:626 KIRBY ROAD
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-1047
Mailing Address - Country:US
Mailing Address - Phone:336-983-4565
Mailing Address - Fax:
Practice Address - Street 1:626 KIRBY ROAD
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:NC
Practice Address - Zip Code:27021-1047
Practice Address - Country:US
Practice Address - Phone:336-983-4565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC43781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1932132396OtherNPI