Mark John Modjean, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

8439 Issued in MN

Practice address

7001 Nicollet Ave
Richfield, MN 55423-3162

Phone

(612) 866-3322

NPI assigned

Dec 22, 2011

Last updated

Dec 22, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mark J Modjean DDS PA

  • Dentist
  • Richfield, MN
  • NPI 1538140934
  NPD (past) Authorized official

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

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324512000000",
    "number": "1275802092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7001 NICOLLET AVE",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554233162",
            "telephone_number": "612-866-3322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7001 NICOLLET AVE",
            "city": "RICHFIELD",
            "state": "MN",
            "postal_code": "554233162",
            "telephone_number": "612-866-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODJEAN",
        "first_name": "MARK",
        "middle_name": "JOHN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-22",
        "last_updated": "2011-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "8439",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Rae Mislivec, MSN, APRN, PMHNP-BC
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• Kowsar Abdullahi Mohamed
• Mohamed Ali Mohamed
• Sameeha Mohamed
• Amal Mohamed Mohamoud

• Dentist in Richfield, MN
• Providers in Richfield, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.