1801009469 NPI number — DR. REBECCA EATON MONTGOMERY DDS

Table of content: DR. REBECCA EATON MONTGOMERY DDS (NPI 1801009469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801009469 NPI number — DR. REBECCA EATON MONTGOMERY DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
REBECCA
Provider Middle Name:
EATON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EATON
Provider Other First Name:
REBECCA
Provider Other Middle Name:
GALE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801009469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 E WOODFIELD RD
Provider Second Line Business Mailing Address:
SUITE 100E
Provider Business Mailing Address City Name:
SCHAUMBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60173-6052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-517-2800
Provider Business Mailing Address Fax Number:
847-517-8770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 E WOODFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 100E
Provider Business Practice Location Address City Name:
SCHAUMBURG
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60173-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-517-2800
Provider Business Practice Location Address Fax Number:
847-517-8770
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  19027067 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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