Provider Demographics
NPI:1013288752
Name:MODERN DENTAL PROFESSIONALS CO, PC
Entity Type:Organization
Organization Name:MODERN DENTAL PROFESSIONALS CO, PC
Other - Org Name:BRIGHTNOW PARKER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-428-2000
Mailing Address - Street 1:11183 S PARKER RD
Mailing Address - Street 2:UNIT C
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4904
Mailing Address - Country:US
Mailing Address - Phone:303-840-2204
Mailing Address - Fax:
Practice Address - Street 1:11183 S PARKER RD
Practice Address - Street 2:UNIT C
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4904
Practice Address - Country:US
Practice Address - Phone:303-840-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty