NPIMap

Organization Active NPI

Modern Dental

  • Dental Clinic/Center
  • Richardson, TX
National Provider Identifier
1780998443
Registry record updated Aug 4, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
22246 Issued in TX
Legal business name
MODERN DENTAL
Practice address
3610 Shire Blvd
Suite 204
Richardson, TX 75082-2241
Phone
(972) 578-6633
NPI assigned
Aug 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2010

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

Authorized official

Name
Dr. Mitchell Kim, D.D.S.NPI 1437275047
Title
President
Phone
(972) 578-6633

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 22246 TX Primary

Addresses

Primary practice location

3610 Shire Blvd
Suite 204
Richardson, TX 75082-2241

Mailing address

3610 Shire Blvd
Suite 204
Richardson, TX 75082-2241
Phone (972) 578-6633

National Provider Directory

National Provider Directory

Locations

3610 Shire Blvd
Ste 204
Richardson, TX 75082
Phone (972) 578-6633

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": "1280880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280880000000",
    "number": "1780998443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3610 SHIRE BLVD",
            "address_2": "SUITE 204",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822241",
            "telephone_number": "972-578-6633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3610 SHIRE BLVD",
            "address_2": "SUITE 204",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822241",
            "telephone_number": "972-578-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-04",
        "last_updated": "2010-08-04",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-578-6633",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "TX",
            "license": "22246",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richardson, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2010; 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.