Michelle Emily Modad

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

License

DE61149859 Issued in WA

Practice address

3023 80TH Ave SE Ste 200
Mercer Island, WA 98040-6014

Phone

(206) 690-5417

NPI assigned

Apr 3, 2018

Last updated

Jul 15, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1522713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1982100475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2519 13TH AVE S",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981445008",
            "telephone_number": "573-308-0333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3023 80TH AVE SE STE 200",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980406014",
            "telephone_number": "206-690-5417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODAD",
        "first_name": "MICHELLE",
        "middle_name": "EMILY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-04-03",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "WA",
            "license": "DE61149859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dental Anesthesiology in Mercer Island, WA
• Providers in Mercer Island, WA by specialty
• Dental Anesthesiology in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; 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.