NPIMap

Organization Active NPI

Modern Dental Professionals - Arizona PC

  • General Practice Dentistry
  • Mesa, AZ
National Provider Identifier
1063789816
Registry record updated Nov 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS - ARIZONA PC
Practice address
1855 S Country Club Dr
Ste 101
Mesa, AZ 85210-6037
Phone
(714) 428-2000
NPI assigned
Nov 22, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Roy Smith, DDS
Title
President
Phone
(714) 428-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1855 S Country Club Dr
Ste 101
Mesa, AZ 85210-6037

Mailing address

1855 S Country Club Dr
Ste 101
Mesa, AZ 85210-6037
Phone (714) 428-2000

Other names 1

  • BRIGHTNOW MESA COUNTRY CLUB DR Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bright Now Dental5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321920000000",
    "number": "1063789816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 S COUNTRY CLUB DR",
            "address_2": "STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106037",
            "telephone_number": "714-428-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 S COUNTRY CLUB DR",
            "address_2": "STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852106037",
            "telephone_number": "714-428-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS - ARIZONA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-22",
        "last_updated": "2011-11-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-428-2000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRIGHTNOW MESA COUNTRY CLUB DR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mesa, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.