Fort Myers Modern Dentistry, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

FORT MYERS MODERN DENTISTRY, PA

Practice address

3330 Forum Blvd
Fort Myers, FL 33905-5578

Phone

(239) 241-9128

NPI assigned

May 13, 2024

Organization subpart

No

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

Authorized official

Name

Kelsey Archer

Title

Owner

Phone

(714) 845-8500

Specialties & licenses 1

Addresses

Locations

Practitioners 2

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

• Rupam Rana, DDS

  • Dentist
  • Fort Myers, FL
  • NPI 1649868837

  General Practice

  NPD
• Maria Victoria Flecha, DMD

  • General Practice Dentistry
  • Fort Myers, FL
  • NPI 1356041016
  NPD (past)

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

{
    "created_epoch": "1715558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1245088319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 FORUM BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339055578",
            "telephone_number": "239-241-9128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MYERS MODERN DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-13",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A",
        "authorized_official_last_name": "ARCHER",
        "authorized_official_first_name": "KELSEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-845-8500"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Fort Myers Injury Center LLC
• Fort Myers Internal Medicine LLC
• Fort Myers Kidney Center LLC (Fort Myers Kidney Care Center)
• Fort Myers Medical Universer
• Fort Myers Nursing Agency
• Fort Myers Nuviva Medical Weight Loss Inc
• Fort Myers Osl Operating LLC (The Opal at Lakes Park)
• Fort Myers Pediatrics LLC
• Fort Myers Primary Care and Wellness LLC

• General Practice Dentistry in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2024; 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.