Modelevsky DDS PA

Primary specialty

Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X

License

2302 Issued in AR

Legal business name

MODELEVSKY DDS PA

Practice address

906 Osler Dr
Jonesboro, AR 72401-4366

Phone

(870) 972-8570

Fax

(870) 972-5451

NPI assigned

Jun 6, 2008

Organization subpart

No

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

Authorized official

Name

Teri Modelevsky, JD

Title

Office Manager

Phone

(870) 972-8570

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1212710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340064000000",
    "number": "1922267657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1920",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724031920",
            "telephone_number": "870-972-8570",
            "fax_number": "870-972-5451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 OSLER DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014366",
            "telephone_number": "870-972-8570",
            "fax_number": "870-972-5451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODELEVSKY DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-06",
        "last_updated": "2012-06-19",
        "status": "A",
        "authorized_official_last_name": "MODELEVSKY",
        "authorized_official_first_name": "TERI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "870-972-8570",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": "AR",
            "license": "2302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Mitchem, APRN
• Elisabeth Mixon
• Mobile Radiology Services, Inc.
• Mobility Lift Systems, LLC
• Zachary Lee Mobley
• Stephen Allen Modelevsky, DDS
• Marci Moffitt, PT
• Jacob Paul Moll, O.D.
• Megan Leigh Moll, O.D.
• Joy Molloy, PTA

• Oral and Maxillofacial Surgery Clinic/Center in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Oral and Maxillofacial Surgery Clinic/Center in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.