Provider Demographics
NPI:1487925129
Name:MODERN DENTAL PROFESSIONALS CO,PC
Entity type:Organization
Organization Name:MODERN DENTAL PROFESSIONALS CO,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:951 E 120TH AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-5718
Mailing Address - Country:US
Mailing Address - Phone:303-305-4466
Mailing Address - Fax:303-920-0861
Practice Address - Street 1:951 E 120TH AVE
Practice Address - Street 2:UNIT D
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-5718
Practice Address - Country:US
Practice Address - Phone:303-305-4466
Practice Address - Fax:303-920-0861
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