NPIMap

Organization Active NPI

Glendale Modern Dentistry, LLP

Doing business as Glendale Modern Dentistry

  • Dentist
  • Glendale, AZ
National Provider Identifier
1255757308
Registry record updated Mar 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
GLENDALE MODERN DENTISTRY, LLP
Doing business as
Glendale Modern Dentistry
Practice address
5143 West Olive Ave, Suite 140
Glendale, AZ 85302
Phone
(623) 939-2600
Fax
(623) 939-2603
NPI assigned
Mar 13, 2014
Last updated
Mar 13, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2014

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

Authorized official

Name
Marissa Brown, DMDNPI 1275882755
Title
Owner Doctor
Phone
(623) 939-2600

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

5143 West Olive Ave, Suite 140
Glendale, AZ 85302

Mailing address

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

Other names 1

  • Glendale Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

5143 W Olive Ave
Ste 140
Glendale, AZ 85302
Phone (623) 939-2600

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394668800000",
    "number": "1255757308",
    "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": "5143 WEST OLIVE AVE, SUITE 140",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "85302",
            "telephone_number": "623-939-2600",
            "fax_number": "623-939-2603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE MODERN DENTISTRY, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-13",
        "last_updated": "2014-03-13",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "MARISSA",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "623-939-2600",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glendale Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; 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.