NPIMap

Organization Active NPI

Modern Dental Professionals - Oklahoma, PC

  • General Practice Dentistry
  • Moore, OK
National Provider Identifier
1306186796
Registry record updated Mar 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS - OKLAHOMA, PC
Practice address
711 SW 19TH Street
Suite 100
Moore, OK 73160
Phone
(972) 212-8135
NPI assigned
Feb 21, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2013

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

Authorized official

Name
Paul Peek, DDS
Title
PC Owner/Dentist
Phone
(972) 212-8135

Specialties & licenses 1

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

Addresses

Primary practice location

711 SW 19TH Street
Suite 100
Moore, OK 73160

Mailing address

6501 Windcrest Dr Ste 100
Plano, TX 75024-3087
Phone (972) 212-8135

Other names 1

  • Monarch Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Modern Dental Professionals - Oklahoma PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

711 SW 19th St
Ste 100
Moore, OK 73160
Phone (405) 913-7622

NPI Registry JSON

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

{
    "created_epoch": "1361404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362096000000",
    "number": "1306186796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 WINDCREST DR STE 100",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750243087",
            "telephone_number": "972-212-8135",
            "fax_number": "972-767-4885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 SW 19TH STREET",
            "address_2": "SUITE 100",
            "city": "MOORE",
            "state": "OK",
            "postal_code": "73160",
            "telephone_number": "972-212-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS - OKLAHOMA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-21",
        "last_updated": "2013-03-01",
        "status": "A",
        "authorized_official_last_name": "PEEK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PC OWNER/DENTIST",
        "authorized_official_telephone_number": "972-212-8135",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monarch Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2013; 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.