Provider Demographics
NPI:1285015669
Name:MODERN DENTAL PROFESSIONALS CO PC
Entity Type:Organization
Organization Name:MODERN DENTAL PROFESSIONALS CO PC
Other - Org Name:BRIGHT NOW DENTAL COLORADO SPRINGS / CITADEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:MELLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-209-2250
Mailing Address - Street 1:PO BOX 25153
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-5153
Mailing Address - Country:US
Mailing Address - Phone:714-578-6358
Mailing Address - Fax:949-242-2631
Practice Address - Street 1:701 CITADEL DR E
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5302
Practice Address - Country:US
Practice Address - Phone:719-574-7828
Practice Address - Fax:719-574-8122
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MODERN DENTAL PROFESSIONALS CO PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1057341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty