NPIMap

Organization Active NPI

Modern Dental Professionals Dallas/Ft. Worth PC

Doing business as Monarch Dental - Granbury

  • General Practice Dentistry
  • Granbury, TX
National Provider Identifier
1730469545
Registry record updated Aug 24, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
MODERN DENTAL PROFESSIONALS DALLAS/FT. WORTH PC
Doing business as
Monarch Dental - Granbury
Practice address
3902 E. US Highway 377
#100
Granbury, TX 76049
Phone
(682) 498-4400
NPI assigned
Aug 24, 2011
Last updated
Aug 24, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
MODERN DENTAL PROFESSIONALS DALLAS/FT. WORTH PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 24, 2011

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

Authorized official

Name
Dr. Roy D Smith, DDS
Title
Owner
Phone
(972) 212-8121

Specialties & licenses 1

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

Addresses

Primary practice location

3902 E. US Highway 377
#100
Granbury, TX 76049

Mailing address

6501 Windcrest Dr
#100
Plano, TX 75024-3075
Phone (972) 212-8119

Other names 1

  • Monarch Dental - Granbury 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
Part of
Modern Dental Professionals - Oklahoma PC

Other organizations with this tax ID 2

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

Locations

3902 E US Highway 377
Ste 100
Granbury, TX 76049
Phone (682) 498-4400

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314144000000",
    "number": "1730469545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6501 WINDCREST DR",
            "address_2": "#100",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750243075",
            "telephone_number": "972-212-8119",
            "fax_number": "972-767-4885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3902 E. US HIGHWAY 377",
            "address_2": "#100",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "76049",
            "telephone_number": "682-498-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS DALLAS/FT. WORTH PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MODERN DENTAL PROFESSIONALS DALLAS/FT. WORTH PC",
        "enumeration_date": "2011-08-24",
        "last_updated": "2011-08-24",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-212-8121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monarch Dental - Granbury",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Granbury, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; 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.