Active NPI
Shideh Modjarrad, D.D.S
- Dentist
- Dallas, TX
National Provider Identifier
1235275116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 19368
- Practice address
- 5365 Spring Valley Rd
#130
Dallas, TX 75254-3097 - Phone
- (972) 386-4999
- Fax
- (972) 386-4964
- NPI assigned
- Jan 29, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 19368 | TX | Primary |
Addresses
Primary practice location
5365 Spring Valley Rd
#130
Dallas, TX 75254-3097
Mailing address
5365 Spring Valley Rd.
Suit# 130
Dallas, TX 75254
Phone (972) 386-4999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19368 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332201600000",
"number": "1235275116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5365 SPRING VALLEY RD.",
"address_2": "SUIT# 130",
"city": "DALLAS",
"state": "TX",
"postal_code": "75254",
"telephone_number": "972-386-4999",
"fax_number": "972-386-4964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5365 SPRING VALLEY RD",
"address_2": "#130",
"city": "DALLAS",
"state": "TX",
"postal_code": "752543097",
"telephone_number": "972-386-4999",
"fax_number": "972-386-4964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODJARRAD",
"first_name": "SHIDEH",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-01-29",
"last_updated": "2012-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "19368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.