NPIMap

Organization Active NPI

Modern Dental Professionals-Lee,Inc

  • General Practice Dentistry
  • Arcanum, OH
National Provider Identifier
1992989412
Registry record updated Dec 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
30.019758 Issued in OH
Legal business name
MODERN DENTAL PROFESSIONALS-LEE,INC
Practice address
1 S High St
Arcanum, OH 45304-1118
Phone
(937) 692-5150
NPI assigned
Dec 19, 2007
Organization subpart
Yes
Parent organization
MODERN DENTAL PROFESSIONALS-LEE,INCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Rhonda Keller
Title
District Manager
Phone
(937) 278-7956

Practitioners 1

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

National Provider Directory

National Provider Directory
Tax ID family
Modern Dental Professionals-Leeinc9 organizations share this tax ID, including this one
Part of
Modern Dental Professionals-Leeinc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1 S High St
Arcanum, OH 45304
Phone (937) 692-5150

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X 30.019758 OH Primary

Addresses

NPPES NPI Registry

Primary practice location

1 S High St
Arcanum, OH 45304-1118

Mailing address

1 S High St
Arcanum, OH 45304-1118
Phone (937) 692-5150

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
2181400MedicaidOH

Other names 1

NPPES NPI Registry
  • MONARCH DENTAL Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Dec 19, 2007.

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198022400000",
    "number": "1992989412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 S HIGH ST",
            "city": "ARCANUM",
            "state": "OH",
            "postal_code": "453041118",
            "telephone_number": "937-692-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S HIGH ST",
            "city": "ARCANUM",
            "state": "OH",
            "postal_code": "453041118",
            "telephone_number": "937-692-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DENTAL PROFESSIONALS-LEE,INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MODERN DENTAL PROFESSIONALS-LEE,INC",
        "enumeration_date": "2007-12-19",
        "last_updated": "2007-12-19",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "DISTRICT MANAGER",
        "authorized_official_telephone_number": "937-278-7956"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.019758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2181400",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MONARCH DENTAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arcanum, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; 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.