NPIMap

Organization Active NPI

Modern Dental Professionals Colorado PC

  • General Practice Dentistry
  • Colorado Springs, CO
National Provider Identifier
1083095194
Registry record updated Jun 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
105731 Issued in CO
Legal business name
MODERN DENTAL PROFESSIONALS COLORADO PC
Practice address
7136 N Academy Blvd
Colorado Springs, CO 80920-3185
Phone
(719) 452-4120
Fax
(719) 266-0108
NPI assigned
Jun 15, 2015
Organization subpart
Yes
Parent organization
MODERN DENTAL PROFESSIONALS COLORADO PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 2015

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

Authorized official

Name
Dr. Craig A Mellor, DDS
Title
PC Owner
Phone
(303) 209-2250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 105731 CO Primary

Addresses

Primary practice location

7136 N Academy Blvd
Colorado Springs, CO 80920-3185

Mailing address

PO Box 25153
Santa Ana, CA 92799-5153
Phone (714) 578-6358

Other names 1

  • Bright Now Dental Colorado Springs/North Academy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Modern Dental Profesionals Co PC20 organizations share this tax ID, including this one
Part of
Modern Dental Profesionals Co PC

Other organizations with this tax ID 19

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

View all 19

Locations

7136 N Academy Blvd
Colorado Springs, CO 80920
Phone (415) 881-7256

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1434326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434326400000",
    "number": "1083095194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25153",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927995153",
            "telephone_number": "714-578-6358",
            "fax_number": "949-242-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7136 N ACADEMY BLVD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809203185",
            "telephone_number": "719-452-4120",
            "fax_number": "719-266-0108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS COLORADO PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MODERN DENTAL PROFESSIONALS COLORADO PC",
        "enumeration_date": "2015-06-15",
        "last_updated": "2015-06-15",
        "status": "A",
        "authorized_official_last_name": "MELLOR",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PC OWNER",
        "authorized_official_telephone_number": "303-209-2250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "105731",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bright Now Dental Colorado Springs/North Academy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2015; 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.