Provider Demographics
NPI:1639249303
Name:MODERN DENTAL PROFESSIONALS-DALLAS FORT WORTH, PC
Entity Type:Organization
Organization Name:MODERN DENTAL PROFESSIONALS-DALLAS FORT WORTH, 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:KAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-578-6358
Mailing Address - Street 1:8415 DATAPOINT DR
Mailing Address - Street 2:STE. 1020
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3298
Mailing Address - Country:US
Mailing Address - Phone:714-578-6358
Mailing Address - Fax:
Practice Address - Street 1:109 E OVILLA RD
Practice Address - Street 2:STE. 400
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2416
Practice Address - Country:US
Practice Address - Phone:972-617-0208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty