Port Orange Modern Dentistry, PA

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PORT ORANGE MODERN DENTISTRY, PA

Practice address

1765 Dunlawton Ave.
Suite 103
Port Orange, FL 32129

Phone

(386) 259-3905

Fax

(386) 259-3905

NPI assigned

Oct 8, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Minh B Pham, DDS

Title

Owner/GP

Phone

(386) 259-3905

Specialties & licenses 1

Addresses

Other names 1

• Port Orange Modern Dentistry Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Xiaojing Fan

  • Dentist
  • Port Orange, FL
  • NPI 1396531281
  NPD (past)
• Shirley Guerra, DMD

  • Dentist
  • Port Orange, FL
  • NPI 1992481683
  NPD (past)
• Tiffany Yoon

  • Dentist
  • Port Orange, FL
  • NPI 1295570307
  NPD (past)

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

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661385600000",
    "number": "1982179818",
    "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": "303-952-0892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1765 DUNLAWTON AVE.",
            "address_2": "SUITE 103",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "32129",
            "telephone_number": "386-259-3905",
            "fax_number": "386-259-3905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORT ORANGE MODERN DENTISTRY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-08",
        "last_updated": "2022-08-25",
        "certification_date": "2022-08-25",
        "status": "A",
        "authorized_official_last_name": "PHAM",
        "authorized_official_first_name": "MINH",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/GP",
        "authorized_official_telephone_number": "386-259-3905",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Orange Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Port Orange Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Port Orange Adult Day Care, LLC
• Port Orange Chiropractic Inc
• Port Orange Endoscopy & Surgery Center LLC
• Port Orange Gynecology LLC
• Port Orange Internists PA
• Port Orange Pediatrics P a
• Port Orange Physical Therapy Limited Partnership
• Bree Porter
• Dorothy Whatley Porter, PA
• Ann Potopowicz

• Dentist in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 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.