MODERN DENTAL PROFESSIONALS - ARIZONA PC (NPI# 1063789816) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063789816 |
| Entity Type | Organization |
| Organization Name | MODERN DENTAL PROFESSIONALS - ARIZONA PC |
| Other Organization Name | BRIGHTNOW MESA COUNTRY CLUB DR |
| Practice Address |
1855 S Country Club Dr Ste 101 Mesa AZ 85210-6037 |
| Practice Telephone | 7144282000 |
| Mailing Telephone | 7144282000 |
| Enumeration Date | 2011-11-22 |
| Last Update Date | 2011-11-22 |
| Authorized Official Name | DR. ROY SMITH (PRESIDENT) |
| Authorized Official Telephone | 7144282000 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| BRIGHTNOW MESA COUNTRY CLUB DR | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689933947 | Modern Dental Professionals - Arizona PC | Dentist | 2131 E Camelback Road, Ste 102, Phoenix, AZ 85015 | 2012-05-08 |
| Street Address |
1855 S COUNTRY CLUB DR STE 101 |
| City | MESA |
| State | AZ |
| Zip Code | 85210-6037 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932497385 | Kelsey Miles Krause | Dentist | 1855 S Country Club Dr, Suite 101, Mesa, AZ 85210-6037 | 2011-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497382501 | Mesa Center for Family Medicine | Internal Medicine | 2034 S Alma School Road, Suite #101, Mesa, AZ 85210 | 2020-03-26 |
| 1780177121 | Jessica Cannata | Speech-Language Pathologist | 2150 S Country Club Rd, Suite 20, Mesa, AZ 85210 | 2018-06-11 |
| 1831680305 | Alexandra Katherine Ebong | Nurse Practitioner | 1950 S. Country Club Drive, Ste 102, Mesa, AZ 85210 | 2018-05-21 |
| 1548762719 | Russell D. Meldrum, M.d. Pllc | Orthopaedic Surgery | 855 W. Southern Ave., #1114, Mesa, AZ 85210 | 2018-03-05 |
| 1023510435 | Denise M Bruno-krupp | Counselor | 1830 S. Alma School Rd. Suite 101, Mesa, AZ 85210 | 2018-03-01 |
| 1609374529 | Gene R Lullo | Social Worker | 1830 S Alma School Rd Suite 101, Mesa, AZ 85210 | 2018-01-25 |
| 1295264000 | Ashley P Smith | Naturopath | 601 S Alma School Rd, Apt 101, Mesa, AZ 85210 | 2017-06-06 |
| 1386184059 | Brittany Johnson | Counselor | 1745 S Alma School Rd Ste 230, Mesa, AZ 85210 | 2017-03-01 |
| 1487190880 | Mesa Valley Modern Dentistry, LLP | Dentist | 1712 S, Country Club Drive, Ste 104, Mesa, AZ 85210 | 2017-01-10 |
| 1821544529 | Sandra Coren | Licensed Practical Nurse | 32 S Mcdonald, Tlc, Mesa, AZ 85210 | 2016-09-01 |
| Find all providers in zip 85210 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609475060 | Happy Molar Dental LLC | Dentist | 67 N Dobson Rd Ste A-104, Mesa, AZ 85201-6822 | 2020-10-18 |
| 1215553565 | Andrew Eugene Pak | Dentist | 10664 East Point Twenty-two Blvd, Mesa, AZ 85212 | 2020-06-23 |
| 1801438585 | Rauch Dental Associates LLC | Dentist | 2820 E University Dr Ste 108, Mesa, AZ 85213-8505 | 2019-10-14 |
| 1316591407 | George M Magnus | Dentist | 921 S Val Vista Dr Unit 98, Mesa, AZ 85204-5615 | 2019-07-28 |
| 1124672548 | R Keith Farr Dds LLC | Dentist | 4540 E Baseline Rd Ste 111, Mesa, AZ 85206-4616 | 2019-07-25 |
| 1578116679 | Arizona Dental Professionals, P.C. | Dentist | 10749 E Southern Ave, Mesa, AZ 85209-3885 | 2019-07-18 |
| 1629621982 | My Dentist Enterprises, Inc. | Dentist | 2045 S Vineyard Ste 153, Mesa, AZ 85210-6892 | 2019-07-16 |
| 1932761947 | Tyler John Bingham | Dentist | 2537 N Maple, Mesa, AZ 85215-1723 | 2019-07-01 |
| 1598228132 | Joe J Panelli | Dentist | 2824 N Power Rd Ste 108, Mesa, AZ 85215-1673 | 2019-04-10 |
| 1194291997 | Arizona Discount Dentistry Pllc | Dentist | 2500 S Power Rd Ste 127, Mesa, AZ 85209-6689 | 2018-10-18 |
| Find all providers in MESA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.