Brandon Modern Dentistry, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BRANDON MODERN DENTISTRY, PA

Practice address

971 E. Bloomingdale Avenue
Brandon, FL 33511

Phone

(813) 435-3867

Fax

(813) 465-7538

NPI assigned

Aug 8, 2019

Organization subpart

No

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

Authorized official

Name

Minh B Pham, DDS

Title

Owner

Phone

(813) 435-3867

Specialties & licenses 1

Addresses

Other names 1

• Brandon Modern Dentistry Doing business as

Locations

Practitioners 1

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

• Donna Mansour

  • General Practice Dentistry
  • Brandon, FL
  • NPI 1992368112
  NPD (past)

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

{
    "created_epoch": "1565222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1831744655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "971 E. BLOOMINGDALE AVENUE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "33511",
            "telephone_number": "813-435-3867",
            "fax_number": "813-465-7538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON MODERN DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-08",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "MINH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-435-3867",
        "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": "Brandon Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brandon Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brandon Mall Dental P.a.
• Brandon Medical Care LLC
• Brandon Medical Center
• Brandon Medical Wellness Center
• Brandon Mental Health
• Brandon Nephrology PA
• Brandon Oral Surgery and Specialty Center PLLC
• Brandon Pain Medicine, Inc.
• Brandon Plaza Facility LLC
• Brandon Premier Healthcare PA

• General Practice Dentistry in Brandon, FL
• Providers in Brandon, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2022; 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.