NPIMap

Organization Active NPI

Fountain Modern Dentistry and Orthodontics, LLP

  • General Practice Dentistry
  • Irvine, CA
National Provider Identifier
1730434622
Registry record updated Jul 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
9356 Issued in CO
Legal business name
FOUNTAIN MODERN DENTISTRY AND ORTHODONTICS, LLP
Practice address
2860 Michelle Drive 2ND Floor
Irvine, CA 92606
Phone
(714) 368-2077
Fax
(714) 368-2092
NPI assigned
Jul 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2012

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

Authorized official

Name
Charles Rodgers
Title
DDS/ Owner
Phone
(719) 382-4936

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 9356 CO Primary

Addresses

Primary practice location

2860 Michelle Drive 2ND Floor
Irvine, CA 92606

Mailing address

6940 Mesa Ridge Parkway
Fountain, CO 80817
Phone (719) 382-4936

Other names 1

  • Fountain Modern Dentistry and Orthodontics Doing business as

National Provider Directory

National Provider Directory

Locations

6940 Mesa Ridge Pkwy
Fountain, CO 80817
Phone (719) 382-4936

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342483200000",
    "number": "1730434622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6940 MESA RIDGE PARKWAY",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "80817",
            "telephone_number": "719-382-4936",
            "fax_number": "719-382-4938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2860 MICHELLE DRIVE 2ND FLOOR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "92606",
            "telephone_number": "714-368-2077",
            "fax_number": "714-368-2092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN MODERN DENTISTRY AND ORTHODONTICS, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-17",
        "last_updated": "2012-07-17",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DDS/ OWNER",
        "authorized_official_telephone_number": "719-382-4936"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "9356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountain Modern Dentistry and Orthodontics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2012; 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.