NPIMap

Organization Active NPI

Clarksville Modern Dentistry,PC

  • Dentist
  • Clarksville, TN
National Provider Identifier
1104362946
Registry record updated Jan 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
CLARKSVILLE MODERN DENTISTRY,PC
Practice address
1777 Madison Ste Suite 100
Clarksville, TN 37043
Phone
(931) 202-9151
Fax
(931) 218-2724
NPI assigned
Jan 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2017

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

Authorized official

Name
Dr. Joan Thanh To, DDS
Title
Owner Dentist
Phone
(931) 202-9151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

1777 Madison Ste Suite 100
Clarksville, TN 37043

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626
Phone (714) 845-8890

Other names 1

  • Clarksville Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1777 Madison St
Ste 100
Clarksville, TN 37043
Phone (931) 202-9151

Practitioners & affiliated clinicians

Practitioners 6

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": "1484697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1104362946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1777 MADISON STE SUITE 100",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37043",
            "telephone_number": "931-202-9151",
            "fax_number": "931-218-2724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARKSVILLE MODERN DENTISTRY,PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-18",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "TO",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "THANH",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "931-202-9151",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clarksville Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clarksville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.