NPIMap

Organization Active NPI

Grand Prairie Modern Dentistry, PC

Doing business as Grand Prairie Modern Dentistry

  • Dentist
  • Grand Prairie, TX
National Provider Identifier
1952946279
Registry record updated Apr 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
GRAND PRAIRIE MODERN DENTISTRY, PC
Doing business as
Grand Prairie Modern Dentistry
Practice address
1215 Arkansas LN Ste 100
Grand Prairie, TX 75052-7276
Phone
(469) 701-2344
NPI assigned
Nov 11, 2019
Last updated
Apr 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2022

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

Authorized official

Name
Jeffrey L Roberts, DMD
Title
Owner
Phone
(469) 701-2344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X Primary

Addresses

Primary practice location

1215 Arkansas LN Ste 100
Grand Prairie, TX 75052-7276

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8890

Other names 1

  • Grand Prairie Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

1215 Arkansas Ln
Ste 100
Grand Prairie, TX 75052
Phone (469) 701-2344

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649808000000",
    "number": "1952946279",
    "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": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 ARKANSAS LN STE 100",
            "city": "GRAND PRAIRIE",
            "state": "TX",
            "postal_code": "750527276",
            "telephone_number": "469-701-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND PRAIRIE MODERN DENTISTRY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-11",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "469-701-2344",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Prairie Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grand Prairie Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Prairie, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.