NPIMap

Organization Active NPI

Albuquerque Modern Dentists, LLC

  • General Practice Dentistry
  • Albuquerque, NM
National Provider Identifier
1780957969
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ALBUQUERQUE MODERN DENTISTS, LLC
Practice address
6810 Menaul Blvd NE
Suite B
Albuquerque, NM 87110-3725
Phone
(505) 872-1100
Fax
(505) 872-0294
NPI assigned
Feb 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

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

Authorized official

Name
Katie L McCann, DDS
Title
Owner
Phone
(505) 872-1100

Specialties & licenses 1

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

Addresses

Primary practice location

6810 Menaul Blvd NE
Suite B
Albuquerque, NM 87110-3725

Mailing address

17000 Red Hill Ave
Irvine, CA 92614-5626
Phone (714) 845-8890

Other names 1

  • Albuquerque Modern Dentists Doing business as

National Provider Directory

National Provider Directory

Locations

6810 Menaul Blvd NE
Ste B
Albuquerque, NM 87110
Phone (505) 872-1100

Practitioners & affiliated clinicians

Practitioners 5

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": "1329436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407196800000",
    "number": "1780957969",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17000 RED HILL AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145626",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6810 MENAUL BLVD NE",
            "address_2": "SUITE B",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871103725",
            "telephone_number": "505-872-1100",
            "fax_number": "505-872-0294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALBUQUERQUE MODERN DENTISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-17",
        "last_updated": "2014-08-05",
        "status": "A",
        "authorized_official_last_name": "MCCANN",
        "authorized_official_first_name": "KATIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "505-872-1100",
        "authorized_official_credential": "DDS"
    },
    "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": "Albuquerque Modern Dentists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; 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.