NPIMap

Organization Active NPI

Modern Dental Professionals Co PC

  • General Practice Dentistry
  • Colorado Springs, CO
National Provider Identifier
1285015669
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
105734 Issued in CO
Legal business name
MODERN DENTAL PROFESSIONALS CO PC
Practice address
701 Citadel Dr E
Colorado Springs, CO 80909-5302
Phone
(719) 574-7828
Fax
(719) 574-8122
NPI assigned
Jun 11, 2015
Organization subpart
Yes
Parent organization
MODERN DENTAL PROFESSIONALS CO PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

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

Authorized official

Name
Dr. Craig A Mellor, DDS
Title
PC Owner
Phone
(303) 209-2250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 105734 CO Primary

Addresses

Primary practice location

701 Citadel Dr E
Colorado Springs, CO 80909-5302

Mailing address

PO Box 25153
Santa Ana, CA 92799-5153
Phone (714) 578-6358

Other names 1

  • Bright Now Dental Colorado Springs / Citadel Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Modern Dental Profesionals Co PC20 organizations share this tax ID, including this one
Part of
Modern Dental Profesionals Co PC

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

701 Citadel Dr E
Colorado Springs, CO 80909
Phone (719) 574-7288

NPI Registry JSON

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1285015669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25153",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927995153",
            "telephone_number": "714-578-6358",
            "fax_number": "949-242-2631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 CITADEL DR E",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095302",
            "telephone_number": "719-574-7828",
            "fax_number": "719-574-8122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS CO PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MODERN DENTAL PROFESSIONALS CO PC",
        "enumeration_date": "2015-06-11",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "MELLOR",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PC OWNER",
        "authorized_official_telephone_number": "303-209-2250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "105734",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bright Now Dental Colorado Springs / Citadel",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; 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.