Provider Demographics
NPI:1770793069
Name:MONTGOMERY, KATHRYN KALKREUTH (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:KALKREUTH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:L
Other - Last Name:KALKREUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1180 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040
Mailing Address - Country:US
Mailing Address - Phone:937-642-1151
Mailing Address - Fax:937-642-1105
Practice Address - Street 1:1180 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040
Practice Address - Country:US
Practice Address - Phone:937-642-1151
Practice Address - Fax:937-642-1105
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0223731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice