NPIMap

Organization Active NPI

Aurora Modern Dental, LLC

  • General Practice Dentistry
  • Aurora, IL
National Provider Identifier
1528381399
Registry record updated Mar 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
019027170 Issued in IL
Legal business name
AURORA MODERN DENTAL, LLC
Practice address
808 N Route 59
Aurora, IL 60504-4912
Phone
(630) 692-0500
Fax
(630) 806-8082
NPI assigned
Mar 9, 2010
Last updated
Mar 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2010

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

Authorized official

Name
Dr. Kianor Shahmohammadi, DMD
Title
Ceo - Nexus Dentistry
Phone
(618) 917-5808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 019027170 IL Primary

Addresses

Primary practice location

808 N Route 59
Aurora, IL 60504-4912

Mailing address

808 N Route 59
Aurora, IL 60504-4912
Phone (630) 692-0500

Other names 1

  • Aurora Modern Dental Other name

National Provider Directory

National Provider Directory
Tax ID family
Aurora Modern Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1268092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268092800000",
    "number": "1528381399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "808 N ROUTE 59",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605044912",
            "telephone_number": "630-692-0500",
            "fax_number": "630-806-8082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "808 N ROUTE 59",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605044912",
            "telephone_number": "630-692-0500",
            "fax_number": "630-806-8082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AURORA MODERN DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-09",
        "last_updated": "2010-03-09",
        "status": "A",
        "authorized_official_last_name": "SHAHMOHAMMADI",
        "authorized_official_first_name": "KIANOR",
        "authorized_official_title_or_position": "CEO - NEXUS DENTISTRY",
        "authorized_official_telephone_number": "618-917-5808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019027170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aurora Modern Dental",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; 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.