JAKE MODERY (NPI# 1205217445) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205217445 |
| Entity Type | Individual |
| Full Name | JAKE MODERY |
| Credential | D.D.S. |
| Practice Address |
9200 Town Square Blvd Suite 1090 Amarillo TX 79119-1250 |
| Mailing Address |
5902 S Fannin St Amarillo TX 79118-8807 |
| Practice Telephone | 8067311180 |
| Practice Fax Number | 8064144680 |
| Mailing Telephone | 8067311180 |
| Mailing Fax Number | 8064144680 |
| Enumeration Date | 2015-06-13 |
| Last Update Date | 2016-09-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 30983 | TX | Dental Providers |
| Street Address |
9200 TOWN SQUARE BLVD SUITE 1090 |
| City | AMARILLO |
| State | TX |
| Zip Code | 79119-1250 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538512421 | Jake Modery, D.d.s., P.C. | Clinic/Center | 9200 Town Square Blvd, Suite 1090, Amarillo, TX 79119-1250 | 2016-07-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063055135 | Cindy Kay Farley | Technician | 10511 Perry Lane #5, Amarillo, TX 79119 | 2019-10-22 |
| 1033771803 | Amy Stephenson | Dentist | 7649 Hillside Road, Suite 100, Amarillo, TX 79119 | 2019-07-02 |
| 1225535321 | Chad Pearson | Chiropractor | 8950 Soncy Rd, Suite 400, Amarillo, TX 79119 | 2018-04-06 |
| 1518418250 | Er On Soncy, LLC | Clinic/Center | 3530 S. Soncy Rd., Amarillo, TX 79119 | 2016-10-18 |
| 1003362377 | Coulter Emergency Center LLC | Clinic/Center | 5800 S. Coulter St, Amarillo, TX 79119 | 2016-08-28 |
| 1427502921 | Wilfred Omoghibora Ukhurebor | Dentist | 206 Ne 7th Avenue, Amarillo, TX 79119 | 2016-08-12 |
| 1134512031 | Susan D Sosebee | Dietitian, Registered | 7910 Progress Drive, Amarillo, TX 79119 | 2015-03-17 |
| 1467874537 | Susan Elizabeth Ellington | Internal Medicine | 7659 Hillside Rd, Suite 300, Amarillo, TX 79119 | 2014-01-09 |
| 1568776250 | Sean Woodruff | Dentist | 5051 S. Soncy Rd, Amarillo, TX 79119 | 2010-08-05 |
| 1992948368 | Christopher Aaron Atkins | Dentist | 5051 S Soncy, Amarillo Oral & Maxillofacial Surgery, Amarillo, TX 79119 | 2009-04-14 |
| Find all providers in zip 79119 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760081954 | Amlan Pankaj | Dentist | 802 E Amarillo Blvd # 300, Amarillo, TX 79107-5401 | 2020-10-20 |
| 1194335539 | Delton Todd Tatum | Dentist | 2815 S Georgia St, Amarillo, TX 79109-1975 | 2020-07-31 |
| 1588150098 | Byron Jenaro Malilay Junio | Dentist | 800 E Amarillo Blvd Ste 300, Amarillo, TX 79107-5401 | 2018-07-09 |
| 1427502921 | Wilfred Omoghibora Ukhurebor | Dentist | 206 Ne 7th Avenue, Amarillo, TX 79119 | 2016-08-12 |
| 1003297276 | James William Mcpherson | Dentist | 6601 Ravenwood Ct, Amarillo, TX 79124-1698 | 2015-06-14 |
| 1437538469 | Oneida Dental Pllc | Dentist | 802 E Amarillo Blvd, Suite 300, Amarillo, TX 79107-5401 | 2015-05-22 |
| 1811389216 | Thinh Luong, Dds, P.a. | Dentist | 2207 S Western St, Suite 40, Amarillo, TX 79109-1542 | 2015-02-23 |
| 1780097238 | Austin Sidney Hodges | Dentist | 3419 S Coulter St Ste 1, Amarillo, TX 79109-3998 | 2014-06-03 |
| 1851738884 | Daniel J Meadors | Dentist | 2201 N. Grand, Amarillo, TX 79107 | 2013-05-31 |
| 1306189295 | Ronald Dean Whittington | Dentist | 500 Quail Creek Dr Unit A, Amarillo, TX 79124-1637 | 2013-03-29 |
| Find all providers in AMARILLO | ||||
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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.