Modern Dental Professionals Philadelpha PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

22D102138300 Issued in PA

Legal business name

MODERN DENTAL PROFESSIONALS PHILADELPHA PC

Doing business as

Pro-dent

Practice address

1440 Conchester Hwy
Boothwyn, PA 19061-2124

Phone

(610) 459-0845

NPI assigned

Dec 4, 2006

Last updated

Aug 22, 2020By 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

Lawrence Paul

Title

Owner

Phone

(610) 459-0845

Specialties & licenses 1

Addresses

Other names 1

• Pro-dent Doing business as

Locations

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

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871651992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1440 CONCHESTER HWY",
            "city": "BOOTHWYN",
            "state": "PA",
            "postal_code": "190612124",
            "telephone_number": "610-459-0845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1440 CONCHESTER HWY",
            "city": "BOOTHWYN",
            "state": "PA",
            "postal_code": "190612124",
            "telephone_number": "610-459-0845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS PHILADELPHA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PAUL",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-459-0845"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "22D102138300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pro-dent",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Manuel T. Lim, MD
• Issam Malkoun, OPTICIAN
• Steven Marinakis, DMD
• Timothy A Martin, D.C.
• Louis M. Micolucci, R.PH.
• Lauren Moyer, M.S., CCC-SLP
• Shaun T Mullan, CMT
• Naamans Creek Care Inc (Naamans Creek Country Manor)
• Nicole Marie Nelson, M.S. CCC-SLP
• Lisa Ann Noone

• General Practice Dentistry in Boothwyn, PA
• Providers in Boothwyn, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.