NPIMap

Organization Active NPI

Modern Dental Professionals-Lee,Inc

  • General Practice Dentistry
  • Piqua, OH
National Provider Identifier
1669656104
Registry record updated Dec 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30.019758 Issued in OH
Legal business name
MODERN DENTAL PROFESSIONALS-LEE,INC
Practice address
987 E Ash St
Ste 154
Piqua, OH 45356-4133
Phone
(937) 778-0150
NPI assigned
Dec 19, 2007
Organization subpart
Yes
Parent organization
MODERN DENTAL PROFESSIONALS-LEE,INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 19, 2007

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

Authorized official

Name
Rhonda Keller
Title
District Manager
Phone
(937) 278-7956

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 30.019758 OH Primary

Addresses

Primary practice location

987 E Ash St
Ste 154
Piqua, OH 45356-4133

Mailing address

987 E Ash St
Ste 154
Piqua, OH 45356-4133
Phone (937) 778-0150

Other identifiers 1

IdentifierTypeStateIssuer
2181428MedicaidOH

Other names 1

  • MONARCH DENTAL Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Modern Dental Professionals-Leeinc9 organizations share this tax ID, including this one
Part of
Modern Dental Professionals-Leeinc

Other organizations with this tax ID 8

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

Locations

987 E Ash St
Ste 154
Piqua, OH 45356
Phone (937) 778-0150

Practitioners & affiliated clinicians

Practitioners 1

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": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198022400000",
    "number": "1669656104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "987 E ASH ST",
            "address_2": "STE 154",
            "city": "PIQUA",
            "state": "OH",
            "postal_code": "453564133",
            "telephone_number": "937-778-0150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "987 E ASH ST",
            "address_2": "STE 154",
            "city": "PIQUA",
            "state": "OH",
            "postal_code": "453564133",
            "telephone_number": "937-778-0150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS-LEE,INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MODERN DENTAL PROFESSIONALS-LEE,INC",
        "enumeration_date": "2007-12-19",
        "last_updated": "2007-12-19",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "DISTRICT MANAGER",
        "authorized_official_telephone_number": "937-278-7956"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.019758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2181428",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MONARCH DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Piqua, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; 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.