1. Home
  2. Directory
  3. Illinois
  4. St Charles
  5. Dentist
  6. NPI Profile

ST. CHARLES MODERN DENTAL
NPI 1912220773
Dentist - General Practice in St Charles, IL

Active since March 09, 2010
855 S RANDALL RD, ST CHARLES, IL 60174(630) 587-2700(630) 405-1738 Get Directions Write a Review

NPPES record last updated: March 9, 2010. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About St. Charles Modern Dental NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ST. CHARLES MODERN DENTAL (NPI 1912220773) is a healthcare organization registered as a general practice in St Charles, Illinois and active in the NPI registry since March 2010. The organization lists Kianor Shahmohmmadi, Ceo - Nexus Dentistry, as its authorized official.

NPPES Registry Identity

NPI1912220773
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameST. CHARLES MODERN DENTAL, LLC
Location Address855 S RANDALL RDSt Charles, IL 60174-1570
Mailing Address855 S Randall RdSt Charles, IL 60174-1570 · (630) 587-2700 · Fax (630) 405-1738
Phone(630) 587-2700
Fax(630) 405-1738
Organization SubpartNo
Authorized OfficialKianor ShahmohmmadiCeo - Nexus Dentistry · (618) 917-5808
Enumeration DateMarch 9, 2010
✔ NPI 1912220773 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
License✔ Licensed in IL · 019027170
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
855 S RANDALL RD, St Charles, IL 60174
Open in Google Maps ↗

Other Names 1

Other NameSt. Charles Modern Dental

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ST..CHARLES MODERN DENTAL LLC
Dentist (General Practice)
855 S RANDALL RD
ST CHARLES, IL 60174
Kane County (630) 587-2700
DR. STEVE PASIN DDS
Dentist (General Practice)
855 S RANDALL RD
ST CHARLES, IL 60174
Kane County (630) 587-2700
ELIZABETH KOENEN
Pharmacist
855 S RANDALL RD
ST CHARLES, IL 60174
Kane County (630) 762-7210
MARY JOHNSON
Pharmacist (Pharmacotherapy)
855 S RANDALL RD
ST CHARLES, IL 60174
Kane County (616) 430-9555
MEIJER GREAT LAKES LIMITED PARTNERSHIP
Pharmacy (Community/Retail Pharmacy)
855 S RANDALL RD
ST CHARLES, IL 60174
Kane County (630) 762-7210

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is St. Charles Modern Dental, LLC's NPI number?

The NPI number for St. Charles Modern Dental, LLC is 1912220773. It was assigned to this organization in the NPPES registry on March 9, 2010. The provider is also known as St. Charles Modern Dental.

Where is St. Charles Modern Dental, LLC located?

St. Charles Modern Dental, LLC is located at 855 S Randall Rd, St Charles, IL 60174. The listed phone number is (630) 587-2700.

What is St. Charles Modern Dental, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for St. Charles Modern Dental, LLC was last updated on March 9, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.