Provider Demographics
NPI:1578622080
Name:MODERN DENTAL PROFESSIONALS AZ PC
Entity Type:Organization
Organization Name:MODERN DENTAL PROFESSIONALS AZ PC
Other - Org Name:BRIGHT NOW DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAHOON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-971-6622
Mailing Address - Street 1:20235 N CAVE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-4424
Mailing Address - Country:US
Mailing Address - Phone:602-971-6622
Mailing Address - Fax:
Practice Address - Street 1:20235 N CAVE CREEK RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-4424
Practice Address - Country:US
Practice Address - Phone:602-971-6622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD68291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty