Modern Dental Center

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

16908 Issued in MI

Legal business name

MODERN DENTAL CENTER

Practice address

50810 Romeo Plank Rd
Macomb, MI 48044-1123

Phone

(734) 644-7815

NPI assigned

Mar 3, 2015

Last updated

Mar 3, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Maha Zetouna, DDS

Title

President

Phone

(734) 644-7815

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425340800000",
    "number": "1346632122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50810 ROMEO PLANK RD",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480441123",
            "telephone_number": "734-644-7815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50810 ROMEO PLANK RD",
            "city": "MACOMB",
            "state": "MI",
            "postal_code": "480441123",
            "telephone_number": "734-644-7815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-03",
        "last_updated": "2015-03-03",
        "status": "A",
        "authorized_official_last_name": "ZETOUNA",
        "authorized_official_first_name": "MAHA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-644-7815",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MI",
            "license": "16908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diana T Minto, R.PH.
• Shakeela F Mirza, MD
• Lisa Mislevy, RDN
• Laura M Mistalski
• MJ Private Duty LLC (MJ Private Duty)
• Modern Eyes PLLC
• Michael Mommsen
• Janell Montague
• Lisa M Montalto, LPC
• Melissa M Monteleone, CRNA

• Dental Clinic/Center in Macomb, MI
• Providers in Macomb, MI by specialty
• Dental Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 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.