Modern Smiles Dental Group

Primary specialty

DentistTaxonomy code 122300000X

License

61124 Issued in CA

Legal business name

MODERN SMILES DENTAL GROUP

Practice address

827 N Hollywood Way # 213
Burbank, CA 91505-2814

Phone

(818) 588-9585

NPI assigned

Jan 3, 2012

Last updated

Feb 24, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Andrew Martinez

Title

Office Manager / Secretary

Phone

(818) 855-9585

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1325548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1851661169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "827 N HOLLYWOOD WAY # 213",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915052814",
            "telephone_number": "818-588-9585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 N HOLLYWOOD WAY # 213",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915052814",
            "telephone_number": "818-588-9585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN SMILES DENTAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-03",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "OFFICE MANAGER / SECRETARY",
        "authorized_official_telephone_number": "818-855-9585"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "61124",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Burbank, CA
• Providers in Burbank, CA by specialty
• Dentist in California

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