NPIMap

Organization Active NPI

Mount Dora Modern Dentistry, PA

Doing business as Mount Dora Modern Dentistry

  • General Practice Dentistry
  • Eustis, FL
National Provider Identifier
1659815306
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MOUNT DORA MODERN DENTISTRY, PA
Doing business as
Mount Dora Modern Dentistry
Practice address
17365 US Hwy 441
Eustis, FL 32757
Phone
(352) 270-3015
NPI assigned
Dec 15, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Authorized official

Name
Dr. Thien Le, DMD
Title
Owner
Phone
(352) 270-3015

Specialties & licenses 1

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

Addresses

Primary practice location

17365 US Hwy 441
Eustis, FL 32757

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8500

Other names 1

  • Mount Dora Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

17365 US Highway 441
Mount Dora, FL 32757
Phone (352) 270-3015

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1481760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1659815306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17365 US HWY 441",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "32757",
            "telephone_number": "352-270-3015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT DORA MODERN DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-15",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "THIEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-270-3015",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "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": "Mount Dora Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mount Dora Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eustis, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; 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.