Modern Dental Center LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

MODERN DENTAL CENTER LLC

Practice address

101 Camelot Dr Ste 3
Fond Du Lac, WI 54935-8048

Phone

(920) 921-1244

NPI assigned

Feb 25, 2022

Organization subpart

No

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

Authorized official

Name

Victoria Johnson

Title

Cro

Phone

(941) 444-0558

Specialties & licenses 1

Addresses

Other names 1

• Dental Care Alliance Other name

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

{
    "created_epoch": "1645747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784592000000",
    "number": "1689320897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 CAMELOT DR STE 3",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549358048",
            "telephone_number": "920-921-1244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 CAMELOT DR STE 3",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549358048",
            "telephone_number": "920-921-1244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-25",
        "last_updated": "2026-07-21",
        "certification_date": "2026-07-21",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "VICTORIA",
        "authorized_official_title_or_position": "CRO",
        "authorized_official_telephone_number": "941-444-0558"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dental Care Alliance",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Makenna Mitchell
• Kathy Mitchem
• Leonora Mitre
• Courtney Miyamoto, DDS
• Tiffany Lynn Mlodzik, APNP
• David G Moehn, MS, CCC-SLP
• Jordan Moehn, MS, LAT, ATC
• Amanda Moehring, RN
• Jon T Moen, MD
• Riyazuddin S Mogalai, MD

• Dentist in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2026; 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.