NPIMap

Organization Active NPI

Modern Dental Professionals-Dallas Fort Worth, PC

  • Dentist
  • Red Oak, TX
National Provider Identifier
1639249303
Registry record updated Aug 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
19495 Issued in TX
Legal business name
MODERN DENTAL PROFESSIONALS-DALLAS FORT WORTH, PC
Practice address
109 E Ovilla Rd
Ste. 400
Red Oak, TX 75154-2416
Phone
(972) 617-0208
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2016

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

Authorized official

Name
Dr. Karol L Brown, DDS
Title
Owner
Phone
(714) 578-6358

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 19495 TX Primary

Addresses

Primary practice location

109 E Ovilla Rd
Ste. 400
Red Oak, TX 75154-2416

Mailing address

8415 Datapoint Dr
Ste. 1020
San Antonio, TX 78229-3298
Phone (714) 578-6358

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

109 E Ovilla Rd
Ste 400
Red Oak, TX 75154
Phone (972) 617-0208

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471305600000",
    "number": "1639249303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8415 DATAPOINT DR",
            "address_2": "STE. 1020",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293298",
            "telephone_number": "714-578-6358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 E OVILLA RD",
            "address_2": "STE. 400",
            "city": "RED OAK",
            "state": "TX",
            "postal_code": "751542416",
            "telephone_number": "972-617-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS-DALLAS FORT WORTH, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2016-08-16",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KAROL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-578-6358",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "19495",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monarch Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Red Oak, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2016; 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.