Provider Demographics
NPI:1275603946
Name:MODERN DENTAL PROFESSIONALS ABILENE PC
Entity Type:Organization
Organization Name:MODERN DENTAL PROFESSIONALS ABILENE PC
Other - Org Name:MONARCH DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:325-691-1980
Mailing Address - Street 1:6501 WINDCREST DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3075
Mailing Address - Country:US
Mailing Address - Phone:325-691-1980
Mailing Address - Fax:325-695-1851
Practice Address - Street 1:3329 TURNER PLZ
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8709
Practice Address - Country:US
Practice Address - Phone:325-691-1980
Practice Address - Fax:325-695-1851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty