PORT ORANGE MODERN DENTISTRY, PA (NPI# 1982179818) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982179818 |
| Entity Type | Organization |
| Organization Name | PORT ORANGE MODERN DENTISTRY, PA |
| Practice Address |
1765 Dunlawton Ave. Suite 103 Port Orange FL 32129 |
| Mailing Address |
17000 Red Hill Ave Irvine CA 92614-5626 |
| Practice Telephone | 3862593905 |
| Practice Fax Number | 3862593905 |
| Mailing Telephone | 7148458890 |
| Mailing Fax Number | 3039520892 |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2018-10-08 |
| Authorized Official Name | DR. MINH B PHAM (OWNER/GP) |
| Authorized Official Telephone | 3862593905 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | Dental Providers |
| Other Name | Type Code |
|---|---|
| Port Orange Modern Dentistry | Doing Business As Name - Organization |
| Street Address |
1765 DUNLAWTON AVE. SUITE 103 |
| City | PORT ORANGE |
| State | FL |
| Zip Code | 32129 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932698131 | Brittany Michele Claude | Behavioral Analyst | 4647 Clyde Morris Blvd Suite 501, Port Orange, FL 32129 | 2018-05-03 |
| 1760919468 | Makayla Earl | Behavior Technician | 1557 Town Park Dr., Port Orange, FL 32129 | 2017-05-12 |
| 1184157968 | Katie Lynn Weisz | Physician Assistant | 3635 South Clyde Morris Blvd, Suite 100, Port Orage, FL 32129 | 2017-04-07 |
| 1285178319 | Mallory Driggers | Counselor | 980 Canal View Blvd Apt F7, Port Orange, FL 32129 | 2016-12-08 |
| 1912321654 | Edward L. Staudt Dds & Kenneth L. Staudt Dds, Mph | Dentist | 944 Bridgewater Dr., Suite 2-b, Port Orange, FL 32129 | 2014-02-18 |
| 1538411731 | Roberta Ann Gilmartin | Specialist | 1048 W Samms Ave, Port Orange, FL 32129 | 2012-10-11 |
| 1679892996 | Pamela Kirby Pa | Clinic/Center | 4606 South Clyde Morris Boulevard, Suite 1j, Port Orange, FL 32129 | 2010-05-26 |
| 1326376385 | Connie Jeanne Bodnarik | Physical Therapy Assistant | 3780 S Clyde Morris Blvd Apt 1206, Port Orange, FL 32129 | 2009-12-02 |
| 1669645057 | American Family & Sports Chiropractic Center Inc | Chiropractor | 4649 Clyde Morris Blvd Unit 609, Port Orange, FL 32129 | 2008-04-08 |
| 1831212182 | Lydia Marin Calimarea Dmd,pa | Dentist | 1525 Herbert Street,suit 101, Poret Orange, FL 32129 | 2007-04-09 |
| Find all providers in zip 32129 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003416017 | Phillip Jeffery Kelemen | Dentist | 5913 Plainview Dr, Port Orange, FL 32127-8911 | 2020-10-28 |
| 1497317242 | Nery Ruano | Dentist | 5445 S Williamson Blvd, Port Orange, FL 32128-7399 | 2019-07-02 |
| 1730614157 | Lakshmi Prathyusha Nannapaneni | Dentist | 3781 S Nova Rd Ste B, Port Orange, FL 32129-4285 | 2017-04-23 |
| 1407215965 | Smiles Kingdom Inc | Dentist | 3751 Clyde Morris Blvd, Unit 7, Port Orange, FL 32129-2356 | 2016-02-12 |
| 1811373343 | Nishita Dipakkumar Patel | Dentist | 5400 S Williamson Blvd, Apt #3-207, Port Orange, FL 32128-3702 | 2015-08-06 |
| 1275894560 | Sean Michael Bannan | Dentist | 4410 S Ridgewood Ave, Port Orange, FL 32127-4516 | 2012-06-03 |
| 1700107810 | Hang Van | Dentist | 4184 Mayfair Ln, Port Orange, FL 32129-7506 | 2010-06-13 |
| 1659503910 | John Kulaga | Dentist | 1221 Dunlawton Ave, Port Orange, FL 32127-8950 | 2009-08-19 |
| 1093916819 | Nelly Guirgis Haddad | Dentist | 3755a S Nova Rd, Port Orange, FL 32129-4233 | 2007-05-30 |
| 1154542397 | Christie Jean Latulippe | Dentist | 3781 S Nova Rd, Port Orange, FL 32129-4291 | 2007-05-02 |
| Find all providers in PORT ORANGE | ||||
| City | PORT ORANGE |
| Zip Code | 32129 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.