NPIMap

Organization Active NPI

Modern Dental Incorporated

  • General Practice Dentistry
  • El Paso, TX
National Provider Identifier
1114220647
Registry record updated Feb 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
25146 Issued in TX
Legal business name
MODERN DENTAL INCORPORATED
Practice address
1821 N Zaragosa
Suite 207-316
El Paso, TX 79936-7912
Phone
(866) 371-5205
NPI assigned
Dec 5, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2011

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

Authorized official

Name
Dr. Marsha Amanda, D.M.D
Title
President
Phone
(866) 371-5205

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 25146 TX Primary

Addresses

Primary practice location

1821 N Zaragosa
Suite 207-316
El Paso, TX 79936-7912

Mailing address

1821 N Zaragosa
Suite 207-316
El Paso, TX 79936-7912
Phone (866) 371-5205

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1291507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296691200000",
    "number": "1114220647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 N ZARAGOSA",
            "address_2": "SUITE 207-316",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799367912",
            "telephone_number": "866-371-5205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 N ZARAGOSA",
            "address_2": "SUITE 207-316",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799367912",
            "telephone_number": "866-371-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-05",
        "last_updated": "2011-02-03",
        "status": "A",
        "authorized_official_last_name": "AMANDA",
        "authorized_official_first_name": "MARSHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "866-371-5205",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "25146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 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.