Concordia Plus Schedule of Benefits€¦ · D1553 Re-cement or re-bond bilateral space 5 maintainer...
Transcript of Concordia Plus Schedule of Benefits€¦ · D1553 Re-cement or re-bond bilateral space 5 maintainer...
Concordia Plus Schedule of Benefits Transport Workers Union
IMPORTANT INFORMATION ABOUT YOUR PLANThis schedule of benefits provides a listing of procedures covered by your plan. For procedures that require a copayment, the amount to be paid is shown in the column titled “Member Pays $.” You pay these copayments to the dental office at the time of service.
4
You must select a United Concordia Primary Dental Office (PDO) to receive covered services. Your PDO will perform the below procedures or refer you to a specialty care dentist for further care. Treatment by an Out-of-Network dentist is not covered, except as described in the Certificate of Coverage.
4
Only procedures listed on this Schedule of Benefits are Covered Services. For services not listed (not covered), You are responsible for the full fee charged by the dentist. Procedure codes and member Copayments may be updated to meet American Dental Association (ADA) Current Dental Terminology (CDT) in accordance with national standards.
4
For a complete description of your plan, please refer to the Certificate of Coverage and the Schedule of Exclusions and Limitations in addition to this Schedule of Benefits.
4
If you have any questions about your United Concordia dental plan, please call our Customer Service Department toll-free at 1-866-357-3304 or access our website at www.UnitedConcordia.com.
4
ADA Code
ADA Description
Member Pays $
CLINICAL ORAL EVALUATIONS
D0120 0Periodic Oral Evaluation - Established Patient
D0140 0Limited Oral Evaluation - Problem Focused
D0150 0Comprehensive Oral Evaluation - New Or Established Patient
D0160 0Detailed And Extensive Oral Evaluation - Problem Focused, By Report
D0170 0Re-Evaluation-Limited, Problem Focused (Established Patient; Not Post-Operative Visit)
D0180 0Comprehensive Periodontal EvaluationRADIOGRAPHS/DIAGNOSTIC IMAGING (including interpretation)
D0210 0Intraoral - Complete Series Of Radiographic Images
D0220 0Intraoral- Periapical First Radiographic Image
D0230 0Intraoral- Periapical Each Additional Radiographic Image
D0240 0Intraoral - Occlusal Radiographic Image
D0250 0Extra-oral - 2D Projection Radiographic Image Created Using A Stationary Radiation Source, And Detector
D0270 0Bitewing - Single Radiographic Image
D0272 0Bitewings - Two Radiographic Images
D0273 0Bitewings - Three Radiographic Images
D0274 0Bitewings - Four Radiographic Images
D0277 0Vertical Bitewings - 7 To 8 Radiographic Images
D0330 0Panoramic Radiographic ImageTESTS AND EXAMINATIONS
D0415 0Collection Of Microorganisms For Culture And Sensitivity
D0425 0Caries Susceptibility Tests
D0431 20Adjunctive Pre-Diagnostic Test That Aids In Detection Of Mucosal Abnormalities Including Premalignant And Malignant Lesions, Not To Include Cytology Or Biopsy Procedures
D0460 0Pulp Vitality Tests
ADA Code
ADA Description
Member Pays $
TESTS AND EXAMINATIONS
D0470 0Diagnostic CastsORAL PATHOLOGY LABORATORY
D0472 0Accession Of Tissue, Gross Examination, Preparation And Transmission Of Written Report
D0473 0Accession Of Tissue, Gross And Microscopic Examination, Preparation And Transmission Of Written Report
D0474 0Accession Of Tissue, Gross And Microscopic Examination, Including Assessment Of Surgical Margins For Presence Of Disease, Preparation And Transmission Of Written Report
DENTAL PROPHYLAXIS
D1110 0
25
Prophylaxis, Adult
Each additional prophylaxis within 6 months based upon the necessity recommended by the Dentist
D1120 0
25
Prophylaxis, Child
Each additional prophylaxis within 6 months based upon the necessity recommended by the DentistTOPICAL FLUORIDE TREATMENT (office procedure)
D1206 0Topical Application Of Fluoride Varnish
D1208 0Topical Application Of Flouride ‐ Excluding Varnish
OTHER PREVENTIVE SERVICES
D1310 0Nutritional Counseling For The Control Of Dental Disease
D1320 0Tobacco Counseling For The Control And Prevention Of Oral Disease
D1330 0Oral Hygiene Instruction
D1351 5Sealant - Per Tooth
D1353 5Sealant Repair - Per Tooth
TWUCurrent Dental Terminology ©2019 American Dental Association. All rights reserved. Page 1TWU 20 (06/19) TWU
ADA Code
ADA Description
Member Pays $
SPACE MAINTENANCE (passive appliances)
D1510 25Space maintainer - fixed, unilateral - per quadrant
D1516 25Space Maintainer - Fixed - bilateral, maxillary
D1517 25Space Maintainer - Fixed - bilateral, mandibular
D1520 35Space maintainer - removable, unilateral - per quadrant
D1526 35Space Maintainer - Removable - bilateral, maxillary
D1527 35Space Maintainer - Removable - bilateral, mandibular
D1551 5Re-cement or re-bond bilateral space maintainer - maxillary
D1552 5Re-cement or re-bond bilateral space maintainer - mandibular
D1553 5Re-cement or re-bond bilateral space maintainer - per quadrant
D1556 10Removal of fixed unilateral space maintainer - per quadrant
D1557 10Removal of fixed unilateral space maintainer - maxillary
D1558 10Removal of fixed unilateral space maintainer - mandibular
D1575 25Distal shoe space maintainer - fixed, unilateral - per quadrant
AMALGAM RESTORATIONS (including polishing)
D2140 0Amalgam - One Surface, Primary Or Permanent
D2150 0Amalgam - Two Surfaces, Primary Or Permanent
D2160 0Amalgam - Three Surfaces, Primary Or Permanent
D2161 0Amalgam - Four Or More Surfaces, Primary Or Permanent
RESIN-BASED COMPOSITE RESTORATIONS - DIREC
D2330 0Resin-Based Composite - One Surface, Anterior
D2331 0Resin-Based Composite - Two Surfaces, Anterior
D2332 0Resin-Based Composite - Three Surfaces, Anterior
D2335 0Resin-Based Composite - Four Or More Surfaces Or Involving Incisal Angle (Anterior)
D2390 25Resin-Based Composite Crown, Anterior
D2391 30Resin-Based Composite - One Surface, Posterior
D2392 40Resin-Based Composite - Two Surfaces, Posterior
D2393 55Resin-Based Composite - Three Surfaces, Posterior
D2394 55Resin-Based Composite - Four Or More Surfaces, Posterior
INLAY/ONLAY RESTORATIONS
D2510 150Inlay - Metallic - One Surface u
D2520 150Inlay - Metallic - Two Surfaces u
D2530 150Inlay - Metallic - Three Or More Surfaces u
D2542 150Onlay - Metallic-Two Surfaces u
D2543 150Onlay - Metallic - Three Surfaces u
D2544 150Onlay - Metallic - Four Or More Surfaces u
D2610 175Inlay - Porcelain/Ceramic--One Surface
D2620 175Inlay - Porcelain/Ceramic - Two Surfaces
ADA Code
ADA Description
Member Pays $
INLAY/ONLAY RESTORATIONS
D2630 175Inlay - Porcelain/Ceramic - Three Or More Surfaces
D2642 175Onlay - Porcelain/Ceramic Two Surfaces
D2643 175Onlay - Porcelain/Ceramic Three Surfaces
D2644 175Onlay - Porcelain Ceramic Four Or More Surfaces
D2650 175Inlay - Resin-Based Composite -One Surface
D2651 175Inlay-Resin-Based Composite - Two Surfaces
D2652 175Inlay - Resin-Based Composite -Three Or More Surfaces
D2662 175Onlay - Resin-Based Composite -Two Surfaces
D2663 175Onlay - Resin-Based Composite -Three Surfaces
D2664 175Onlay - Resin-Based Composite - Four Or More Surfaces
CROWNS - SINGLE RESTORATIONS ONLY
D2710 125Crown-Resin-Based Composite (Indirect)
D2712 125Crown - 3/4 Resin-Based Composite (Indirect)
D2720 175Crown, Resin With High Noble Metal u
D2721 175Crown, Resin With Predominantly Base Metal
D2722 175Crown, Resin With Noble Metal u
D2740 225Crown, Porcelain/Ceramic
D2750 175Crown, Porcelain Fused To High Noble Metal u
D2751 175Crown-Porcelain Fused To Predominantly Base Metal
D2752 175Crown, Porcelain Fused To Noble Metal u
D2753 175Crown - porcelain fused to titanium and titanium alloys
D2780 175Crown - 3/4 Cast High Noble Metal u
D2781 175Crown - 3/4 Cast Predominantly Base Metal
D2782 175Crown - 3/4 Cast Noble Metal u
D2783 175Crown - 3/4 Porcelain/Ceramic
D2790 175Crown, Full Cast High Noble Metal u
D2791 175Crown - Full Cast Predominantly Base Metal
D2792 175Crown, Full Cast Noble Metal u
D2794 175Crown - titanium and titanium alloysOTHER RESTORATIVE SERVICES
D2910 0Re-Cement Or Re‐Bond Inlay, Onlay, Veneer Or Partial Coverage Restoration
D2915 0Re‐Cement Or Rebond Indirectly Fabricated Or Prefabricated Post And Core
D2920 0Re-Cement Or Re‐Bond Crown
D2930 25Prefabricated Stainless Steel Crown - Primary Tooth
D2931 25Prefabricated Stainless Steel Crown - Permanent Tooth
D2932 35Prefabricated Resin Crown
D2933 35Prefabricated Stainless Steel Crown With Resin Window
D2940 0Protective Restoration
D2950 25Core Buildup Including Any Pins When Required
D2951 10Pin Retention - Per Tooth, In Addition To Restoration
D2952 35Post And Core In Addition To Crown, Indirectly Fabricated
D2953 25Each Additional Indirectly Fabricated Post - Same Tooth
TWUCurrent Dental Terminology ©2019 American Dental Association. All rights reserved. Page 2TWU 20 (06/19) TWU
ADA Code
ADA Description
Member Pays $
OTHER RESTORATIVE SERVICES
D2954 20Prefabricated Post And Core In Addition To Crown
D2955 10Post Removal
D2957 30Each Additional Prefabricated Post - Same Tooth
D2971 35Additional Procedures To Construct New Crown Under Existing Partial Denture Framework
PULP CAPPING
D3110 0Pulp Cap - Direct (Excluding Final Restoration)
D3120 0Pulp Cap - Indirect (Excluding Final Restoration)
PULPOTOMY
D3220 0Therapeutic Pulpotomy (Excluding Final Restoration)
D3221 15Pulpal Debridement, Primary And Permanent Teeth
ENDODONTIC THERAPY ON PRIMARY TEETH
D3230 25Pulpal Therapy (Resorbable Filling)-Anterior, Primary Tooth (Excluding Final Restoration)
D3240 25Pulpal Therapy (Resorbable Filling)-Posterior, Primary Tooth (Excluding Final Restoration)
ENDODONTIC THERAPY (including treatment plan, clinical procedures and follow-up care)
D3310 75Endodontic Therapy, Anterior Tooth (Excluding Final Restoration)
D3320 150Endodontic Therapy, Premolar Tooth (Excluding Final Restoration)
D3330 275Endodontic Therapy, Molar Tooth (Excluding Final Restoration)
D3331 85Treatment Of Root Canal Obstruction; Non-Surgical Access
D3332 65Incomplete Endodontic Therapy; Inoperable Unrestorable Or Fractured Tooth
D3333 65Internal Root Repair Of Perforation DefectsENDODONTIC RETREATMENT
D3346 100Retreatment Of Previous Root Canal Therapy - Anterior
D3347 170Retreatment Or Previous Root Canal Therapy - Premolar
D3348 295Retreatment Of Previous Root Canal Therapy - MolarAPEXIFICATION/RECALCIFICATION PROCEDURES
D3351 65Apexification/Recalcification ‐ Initial Visit (Apical Closure / Calcific Repair Of Perforations, Root Resorption, Etc.)
D3352 65Apexification/Recalcification - Interim Medication Replacement (Apical Closure/Calcific Repair Of Perforations, Root Resorption, Pulpal Space Disinfection, Etc.)
D3353 65Apexification/Recalcification-Final Visit (Includes Completed Root Canal Therapy-Apical Closure/Calcific Repair Of Perforations, Root Resorption, Etc.)
APICOECTOMY/PERIRADICULAR SERVICES
D3410 95Apicoectomy - Anterior
D3421 95Apicoectomy - Premolar (First Root)
D3425 95Apicoectomy - Molar (First Root)
D3426 55Apicoectomy (Each Additional Root)
D3427 95Periradicular Surgery Without Apicoectomy
ADA Code
ADA Description
Member Pays $
APICOECTOMY/PERIRADICULAR SERVICES
D3430 55Retrograde Filling - Per Root
D3450 95Root Amputation - Per RootOTHER ENDODONTIC PROCEDURES
D3910 15Surgical Procedure For Isolation Of Tooth With Rubber Dam
D3920 90Hemisection (Including Any Root Removal) Not Including Root Canal Therapy
D3950 15Canal Preparation And Fitting Of Preformed Dowel Or Post
SURGICAL SERVICES (including usual postoperative care)
D4210 115Gingivectomy Or Gingivoplasty - Four Or More Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant
D4211 75Gingivectomy Or Gingivoplasty - One To Three Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant
D4240 140Gingival Flap Procedure, Including Root Planing - Four Or More Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant
D4241 85Gingival Flap Procedure, Including Root Planing - One To Three Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant
D4245 165Apically Positioned Flap
D4249 115Clinical Crown Lengthening-Hard Tissue
D4260 325Osseous Surgery (Including Elevation Of A Full Thickness Flap And Closure) – Four Or More Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant
D4261 215Osseous Surgery (Including Elevation Of A Full Thickness Flap And Closure) – One To Three Contiguous Teeth Or Tooth Bounded Spaces Per Quadrant
D4263 175Bone Replacement Graft - Retained Natural Tooth - First Site In Quadrant
D4264 75Bone Replacement Graft - Retained Natural Tooth - Each Additional Site In Quadrant
D4270 215Pedicle Soft Tissue Graft Procedure
D4274 65Mesial/Distal Wedge Procedure, Single Tooth (When Not Performed In Conjunction With Surgical Procedures In The Same Anatomical Area)
D4277 215Free Soft Tissue Graft Procedure (Including Recipient And Donor Surgical Sites), First Tooth, Implant, Or Edentulous Tooth Position In A Graft
D4278 215Free Soft Tissue Graft Procedure (Including Recipient And Donor Surgical Sites), Each Additional Contiguous Tooth, Implant, Or Edentulous Tooth Position In Same Graft Site
NON-SURGICAL PERIODONTAL SERVICES
D4341 40Periodontal Scaling And Root Planing - Four Or More Teeth Per Quadrant
D4342 28Periodontal Scaling And Root Planing - One To Three Teeth Per Quadrant
D4346 30Scaling In Presence Of Generalized Moderate Or Severe Gingival Inflammation - Full Mouth, After Oral Evaluation
D4355 40Full Mouth Debridement To Enable a Comprehensive Oral Evaluation And Diagnosis on a Subsequent Visit
D4381 35Localized Delivery Of Antimicrobial Agents Via Controlled Release Vehicle Into Diseased Crevicular Tissue, Per Tooth
TWUCurrent Dental Terminology ©2019 American Dental Association. All rights reserved. Page 3TWU 20 (06/19) TWU
ADA Code
ADA Description
Member Pays $
OTHER PERIODONTAL SERVICES
D4910 30Periodontal Maintenance
D4920 0Unscheduled Dressing Change (By Someone Other Than Treating Dentist Or Their Staff)
COMPLETE DENTURES (including routine post delivery care)
D5110 225Complete Denture - Maxillary
D5120 225Complete Denture - Mandibular
D5130 250Immediate Denture - Maxillary
D5140 250Immediate Denture - MandibularPARTIAL DENTURES (including routine post-delivery care)
D5211 275Maxillary Partial Denture - Resin Base (Including Retentive/Clasping Materials, Rests And Teeth)
D5212 275Mandibular Partial Denture - Resin Base (Including Retentive/Clasping Materials, Rests And Teeth)
D5213 275Maxillary partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth)
D5214 275Mandibular partial denture - cast metal framework with resin denture bases (including retentive/clasping materials, rests and teeth)
D5225 350Maxillary Partial Denture - Flexible Base (Including Any Clasps, Rests And Teeth)
D5226 350Mandibular Partial Denture - Flexible Base (Including Any Clasps, Rests And Teeth)
D5282 260Removable unilateral partial denture - one piece cast metal (including clasps and teeth), maxillary
D5283 260Removable unilateral partial denture - one piece cast metal (including clasps and teeth), mandibular
D5284 260Removable unilateral partial denture - one piece flexible base (including clasps and teeth) - per quadrant
D5286 260Removable unilateral partial denture - one piece resin (including clasps and teeth) - per quadrant
ADJUSTMENTS TO DENTURES
D5410 0Adjust Complete Denture - Maxillary
D5411 0Adjust Complete Denture - Mandibular
D5421 0Adjust Partial Denture - Maxillary
D5422 0Adjust Partial Denture - MandibularREPAIRS TO COMPLETE DENTURES
D5511 25Repair Broken Complete Denture Base, Mandibular
D5512 25Repair Broken Complete Denture Base, Maxillary
D5520 25Replace Missing Or Broken Teeth-Complete Denture (Each Tooth)
REPAIRS TO PARTIAL DENTURES
D5611 25Repair Resin Partial Denture Base, Mandibular
D5612 25Repair Resin Partial Denture Base, Maxillary
D5621 25Repair Cast Partial Framework, Mandibular
D5622 25Repair Cast Partial Framework, Maxillary
D5630 25Repair Or Replace Broken Retentive Clasping Materials - Per Tooth
D5640 25Replace Broken Teeth-Per Tooth
D5650 25Add Tooth To Existing Partial Denture
ADA Code
ADA Description
Member Pays $
REPAIRS TO PARTIAL DENTURES
D5660 25Add Clasp To Existing Partial Denture - Per Tooth
D5670 150Replace All Teeth And Acrylic On Cast Metal Framework (Maxillary)
D5671 150Replace All Teeth And Acrylic On Cast Metal Framework (Mandibular)
DENTURE REBASE PROCEDURES
D5710 55Rebase Complete Maxillary Denture
D5711 55Rebase Complete Mandibular Denture
D5720 55Rebase Maxillary Partial Denture
D5721 55Rebase Mandibular Partial DentureDENTURE RELINE PROCEDURES
D5730 35Reline Complete Maxillary Denture (Chairside)
D5731 35Reline Complete Mandibular Denture (Chairside)
D5740 35Reline Maxillary Partial Denture (Chairside)
D5741 35Reline Mandibular Partial Denture (Chairside)
D5750 55Reline Complete Maxillary Denture (Laboratory)
D5751 55Reline Complete Mandibular Denture (Laboratory)
D5760 55Reline Maxillary Partial Denture (Laboratory)
D5761 55Reline Mandibular Partial Denture (Laboratory)
D5820 55Interim Partial Denture (Maxillary)
D5821 55Interim Partial Denture (Mandibular)OTHER REMOVABLE PROSTHETIC SERVICES
D5850 10Tissue Conditioning, Maxillary
D5851 10Tissue Conditioning, MandibularFIXED PARTIAL DENTURE PONTICS
D6210 175Pontic-Cast High Noble Metal u
D6211 175Pontic-Cast Predominatly Base Metal
D6212 175Pontic-Cast Noble Metal u
D6214 175Pontic - titanium and titanium alloys
D6240 175Pontic-Porcelain Fused To High Noble Metal u
D6241 175Pontic-Porcelain Fused To Predominantly Base Metal
D6242 175Pontic-Porcelain Fused To Noble Metal u
D6243 175Pontic - porcelain fused to titanium and titanium alloys
D6245 225Pontic - Procelain/Ceramic
D6250 175Pontic, Resin With High Noble Metal u
D6251 175Pontic, Resin With Predominantly Base Metal
D6252 175Pontic, Resin With Noble Metal u
FIXED PARTIAL DENTURE RETAINTERS - INLAYS/ONLAYS
D6600 195Retainer Inlay - Porcelain/Ceramic, Two Surfaces
D6601 195Retainer Inlay - Porcelain/Ceramic, Three Or More Surfaces
D6602 150Retainer Inlay - Cast High Noble Metal, Two Surfaces
u
D6603 150Retainer Inlay - Cast High Noble Metal, Three Or More Surfaces
u
D6604 150Retainer Inlay - Cast Predominantly Base Metal, Two Surfaces
D6605 150Retainer Inlay - Cast Predominantly Base Metal, Three Or More Surfaces
TWUCurrent Dental Terminology ©2019 American Dental Association. All rights reserved. Page 4TWU 20 (06/19) TWU
ADA Code
ADA Description
Member Pays $
FIXED PARTIAL DENTURE RETAINTERS - INLAYS/ONLAYS
D6606 150Retainer Inlay - Cast Noble Metal, Two Surfaces
u
D6607 150Retainer Inlay - Cast Noble Metal, Three Or More Surfaces
u
D6608 205Retainer Onlay - Porcelain/Ceramic, Two Surfaces
D6609 205Retainer Onlay - Porcelain/Ceramic, Three Or More Surfaces
D6610 150Retainer Onlay - Cast High Noble Metal, Two Surfaces
u
D6611 150Retainer Onlay - Cast High Noble Metal, Three Or More Surfaces
u
D6612 155Retainer Onlay - Cast Predominantly Base Metal, Two Surfaces
D6613 155Retainer Onlay - Cast Predominantly Base Metal, Three Or More Surfaces
D6614 150Retainer Onlay - Cast Noble Metal, Two Surfaces
u
D6615 150Retainer Onlay - Cast Noble Metal, Three Or More Surfaces
u
D6624 175Retainer Inlay - Titanium
D6634 175Retainer Onlay - TitaniumFIXED PARTIAL DENTURE RETAINERS - CROWNS
D6720 175Retainer Crown, Resin With High Noble Metal u
D6721 175Retainer Crown, Resin With Predominantly Base Metal
D6722 175Retainer Crown, Resin With Noble Metal u
D6740 225Retainer Crown - Porcelain/Ceramic
D6750 175Retainer Crown, Porcelain Fused To High Noble Metal
u
D6751 175Retainer Crown - Porcelain Fused To Predominantly Base Metal
D6752 175Retainer Crown, Porcelain Fused To Noble Metal
u
D6753 175Retainer crown - porcelain fused to titanium and titanium alloys
D6780 175Retainer Crown, 3/4 Cast High Noble Metal u
D6781 175Retainer Crown - 3/4 Cast Predominantly Base Metal
D6782 175Retainer Crown - 3/4 Cast Noble Metal u
D6783 175Retainer Crown - 3/4 Porcelain/Ceramic
D6784 175Retainer crown 3/4 - titanium and titanium alloys
D6790 175Retainer Crown, Full Cast High Noble Metal u
D6791 175Retainer Crown, Full Cast Predominantly Base Metal
D6792 175Retainer Crown, Full Cast Noble Metal u
D6794 175Retainer crown - titanium and titanium alloysOTHER FIXED PARTIAL DENTURE SERVICES
D6930 0Re‐Cement Or Re-Bond Fixed Partial Denture
D6940 115Stress BreakerEXTRACTIONS (includes local anesthesia, suturing, if needed, and
routine postoperative care)D7111 0Extraction, Coronal Remnants - Primary Tooth
D7140 0Extraction, Erupted Tooth Or Exposed Root (Elevation And/Or Forceps Removal)
ADA Code
ADA Description
Member Pays $
SURGICAL EXTRACTIONS (includes local anesthesia, suturing, if needed, and routine postoperative care)
D7210 25Extraction, Erupted Tooth Requiring Removal Of Bone And/Or Sectioning Of Tooth, And Including Elevation Of Mucoperiosteal Flap If Indicated
D7220 50Removal Of Impacted Tooth - Soft Tissue
D7230 75Removal Of Impacted Tooth - Partially Bony
D7240 115Removal Of Impacted Tooth - Completely Bony
D7241 135Removal Of Impacted Tooth - Completely Bony, With Unusual Surgical Complications
D7250 40Removal Of Residual Tooth Roots (Cutting Procedure)
D7251 115Coronectomy-Intentional Partial Tooth Removal
OTHER SURGICAL PROCEDURES
D7270 50Tooth Reimplantation And/Or Stabilization Of Accidentally Evulsed Or Displaced Tooth
D7280 85Exposure Of An Unerupted Tooth
D7282 90Mobilization Of Erupted Or Malpositioned Tooth To Aid Eruption
D7285 0Incisional Biopsy Of Oral Tissue‐Hard (Bone, Tooth)
D7286 0Incisional Biopsy Of Oral Tissue‐Soft
D7288 0Brush Biopsy - Transepithelial Sample Collection
ALVEOLOPLASTY (surgical preparation of ridge for dentures)
D7310 25Alveoloplasty In Conjunction With Extractions - Four Or More Teeth Or Tooth Spaces, Per Quadrant
D7311 10Alveoloplasty In Conjuction With Extractions - One To Three Teeth Or Tooth Spaces, Per Quandrant
D7320 40Alveoloplasty Not In Conjunction With Extractions - Four Or More Teeth Or Tooth Spaces, Per Quadrant
D7321 20Alveoloplasty Not In Conjunction With Extractions - One To Three Teeth Or Tooth Spaces, Per Quadrant
EXCISION OF BONE TISSUE
D7471 75Removal Of Lateral Exostosis (Maxilla Or Mandible)
D7472 50Removal Of Torus Palatinus
D7473 50Removal Of Torus Mandibularis
D7485 50Reduction Of Osseous TuberositySURGICAL INCISION
D7510 25Incision And Drainage Of Abscess - Intraoral Soft Tissue
D7511 25Incision And Drainage Of Abscess - Intraoral Soft Tissue - Complicated (Includes Drainage Of Multiple Fascial Spaces)
REPAIR OF TRAUMATIC WOUNDS
D7910 25Suture Of Recent Small Wounds Up To 5 CmOTHER REPAIR PROCEDURES
D7960 25Frenulectomy - Also Known As Frenectomy Or Frenotomy - Separate Procedure Not Incidental To Another Procedure
D7963 25Frenuloplasty
D7970 35Excision Of Hyperplastic Tissue - Per Arch
D7971 30Excision Pericoronal Gingival
D7972 100Surgical Reduction Of Fibrous Tuberosity
TWUCurrent Dental Terminology ©2019 American Dental Association. All rights reserved. Page 5TWU 20 (06/19) TWU
ADA Code
ADA Description
Member Pays $
COMPREHENSIVE ORTHODONTIC TREATMENT
D8070 1895Comprehensive Orthodontic Treatment Of Transitional Dentition
D8080 1895Comprehensive Orthodontic Treatment Of Adolescent Dentition
D8090 1895Comprehensive Orthodontic Treatment Of Adult Dentition
OTHER ORTHODONTIC SERVICES
D8999 250Start-up Fee (including exam, beginning records, x-rays, tracing, photos, and models)
D8999 150Post treatment recordsCovered if required by your orthodontist.
D8680 300Orthodontic Retention (Removal Of Appliances, Construction And Placement Of Retainer(S)
UNCLASSIFIED TREATMENT
D9110 10Palliative (Emergency) Treatment Of Dental Pain, Minor Procedures
ANESTHESIA
D9211 0Regional Block Anesthesia
D9212 0Trigeminal Division Block Anesthesia
D9215 0Local Anesthesia In Conjunction With Operative Or Surgical Procedures
D9219 0Evaluation For Moderate Sedation, Deep Sedation Or General Anesthesia
D9222 78Deep Sedation/General Anesthesia - First 15 Minutes
D9223 78Deep Sedation/General Anesthesia - Each Subsequent 15 Mintue Increment
D9239 78Intravenous Moderate (Conscious) Sedation/Analgesia - First 15 Minutes
D9243 78Intravenous Moderate (Conscious) Sedation/Analgesia - Each Subsequent 15 Minute Increment
PROFESSIONAL CONSULTATION
D9310 0Consultation - Diagnostic Service Provided By Dentist Or Physician Other Than Requesting Dentist Or Physician
PROFESSIONAL VISITS
D9430 5Office Visit For Observation (During Regularly Scheduled Hours) - No Other Services Performed
D9440 35Office Visit After Regularly Scheduled Hours
D9450 0Case Presentation, Detailed And Extensive Treatment Planning
MISCELLANEOUS SERVICES
D9930 0Treatment Of Complications (Post-Surgical) Unusual Circumstances, By Report
D9943 21Occlusal Guard Adjustment
D9944 85Occlusal Guard - hard appliance, full arch
D9946 85Occlusal Guard - hard appliance, partial arch
D9951 30Occlusal Adjustment (Limited)
D9952 80Occlusal Adjustment (Complete)
D9972 125External Bleaching - Per Arch - Performed In Office
D9986 10Missed Appointment
D9987 10Cancelled appointment
D9990 0Certified translation or sign-language services - per visit
D9995 0Teledentistry - Synchronous; Real-Time Encounter
ADA Code
ADA Description
Member Pays $
MISCELLANEOUS SERVICES
D9996 0Teledentistry - Asynchronous; Information Stored and Forwarded to Dentist for Subsequent Review
D9997 0Dental care management - patients with special health care needs
FOOTNOTES
u The plan provides for the use of noble metals for inlays, onlays, crowns and bridges. When high noble metal is used, the Covered Person must pay the Copayment for the inlay, onlay, crown or bridge and an added charge equal to the actual laboratory cost of the high noble metal not to exceed $150.
TWUCurrent Dental Terminology ©2019 American Dental Association. All rights reserved. Page 6TWU 20 (06/19) TWU
TexasDirectory of Participating Dental Providers
ConcordiaPLUS PDO
TEXASBEXAR County
SAN ANTONIO - 78216General Dentist
JOHNSON, ERIC A., DDS13487 BLANCO RD (210) 492-0631
Provider ID: 000805927 NPI Number: 1669586509
SAN ANTONIO - 78229General Dentist
CUEVAS, SIMONA, DDS4455 MEDICAL DR (210) 692-0153
Provider ID: 000970251 NPI Number: 1841516382
BRAZORIA CountyPEARLAND - 77581
Multi-Specialty
LALJI DENTAL PC1921 N MAIN ST STE 115 (713) 330-7700
Provider ID: 003481561 NPI Number: 1497890230
PEARLAND - 77584General Dentist
CASTLE DENTAL - PEARLAND10645 BROADWAY ST STE 102 (713) 436-9416
Provider ID: 001738455 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL11302 BROADWAY ST STE 104 (281) 416-5844
Provider ID: 002669579 NPI Number: 1386939213
COLLIN CountyALLEN - 75013General Dentist
MONARCH DENTAL - ALLEN204 CENTRAL EXPY S STE 59 (972) 649-0039
Provider ID: 002691466 NPI Number: 1639249303
MCKINNEY - 75070General Dentist
MONARCH DENTAL - MCKINNEY1720 N CENTRAL EXPY STE 130 (972) 547-6033
Provider ID: 001746871 NPI Number: 1639249303
MONARCH DENTAL - MCKINNEY/CUSTER8910 STATE HIGHWAY 121 STE 210 (214) 383-7676
Provider ID: 001683096 NPI Number: 1639249303
PLANO - 75093General Dentist
MONARCH DENTAL - N PLANO/PRESTON3516 PRESTON RD STE 600 (972) 612-0553
Provider ID: 001682289 NPI Number: 1639249303
DALLAS CountyCARROLLTON - 75006
General Dentist
MONARCH DENTAL - CARROLLTON2540 OLD DENTON RD STE 188 (972) 446-1211
Provider ID: 001683105 NPI Number: 1639249303
CEDAR HILL - 75104General Dentist
MONARCH DENTAL - CEDAR HILL420 E PLEASANT RUN RD STE 390 (469) 272-9333
Provider ID: 001696169 NPI Number: 1639249303
DALLAS - 75206General Dentist
MONARCH DENTAL - DALLAS/MOCKINGBIRD LANE5400 E MOCKINGBIRD LN STE 219 (214) 361-2227
Provider ID: 001683138 NPI Number: 1639249303
DALLAS - 75218General Dentist
MONARCH DENTAL - DALLAS/NORTH BUCKNER9440 GARLAND RD STE 230 (214) 660-0040
Provider ID: 000076900 NPI Number: 1639249303
DALLAS - 75219General Dentist
MONARCH DENTAL - OAK LAWN4140 LEMMON AVE STE 290 (214) 599-0778
Provider ID: 001682839 NPI Number: 1639249303
DALLAS - 75228General Dentist
MONARCH DENTAL - BUCKNER COMMONS9310 E RL THORNTON FWY STE 100 (214) 660-8997
Provider ID: 001836338 NPI Number: 1639249303
DALLAS - 75237General Dentist
MONARCH DENTAL - REDBIRD TOWERS3235 W CAMP WISDOM RD (214) 331-1131
Provider ID: 001683093 NPI Number: 1639249303
DALLAS - 75248General Dentist
MONARCH DENTAL - COIT/BELTLINE7989 BELT LINE RD STE 90 (972) 702-9017
Provider ID: 001580815 NPI Number: 1639249303
DALLAS - 75254General Dentist
MONARCH DENTAL - DALLAS/NORTH DALLAS PKW14400 DALLAS PKWY STE 200 (972) 720-8866
Provider ID: 001683118 NPI Number: 1639249303
DUNCANVILLE - 75116General Dentist
MONARCH DENTAL - DUNCANVILLE201 S CEDAR RIDGE DR (972) 709-9568
Provider ID: 001682283 NPI Number: 1639249303
GARLAND - 75041General Dentist
MONARCH DENTAL - GARLAND/CENTERVILLE1101 W CENTERVILLE RD STE 200 (972) 864-0695
Provider ID: 001682663 NPI Number: 1639249303
GARLAND - 75043General Dentist
SKY, WILLIAM J., DDS328 W INTERSTATE 30 (972) 226-0058
SPLanguage(s):
Provider ID: 000054565 NPI Number: 1720289341
GARLAND - 75044General Dentist
MONARCH DENTAL - GARLAND/BELT LINE RD3325 BELT LINE RD (972) 530-1222
Provider ID: 001683110 NPI Number: 1639249303
GRAND PRAIRIE - 75052General Dentist
MONARCH DENTAL - GRAND PRAIRIE594 W INTERSTATE 20 STE 205 (972) 264-6622
Provider ID: 001682281 NPI Number: 1639249303
IRVING - 75062General Dentist
MONARCH DENTAL - IRVING/AIRPORT FREEWAY3401 W AIRPORT FWY STE 206 (972) 256-6700
Provider ID: 001682665 NPI Number: 1639249303
IRVING - 75063General Dentist
HENEGAR, ANTHONY B., DDS7475 LAS COLINAS BLVD (972) 594-6915
Provider ID: 000848666 NPI Number: 1477586410
MESQUITE - 75150General Dentist
MONARCH DENTAL - MESQUITE/TOWNE CROSSING 3501 TOWNE CROSSING BLVD STE 180 (972) 270-6646
[
Provider ID: 001683156 NPI Number: 1639249303
ROWLETT - 75088General Dentist
MONARCH DENTAL - ROWLETT4305 LAKEVIEW PKWY STE 100 (972) 813-2500
Provider ID: 002103955 NPI Number: 1639249303
DENTON CountyDENTON - 76205
General Dentist
MONARCH DENTAL - DENTON2201 S INTERSTATE 35 E STE L21C (940) 387-1921
Provider ID: 001682662 NPI Number: 1639249303
DENTON - 76210General Dentist
MONARCH DENTAL - CORINTH7650 S INTERSTATE 35 E STE 152 (940) 497-2252
Provider ID: 001682279 NPI Number: 1639249303
FRISCO - 75034Multi-Specialty
MONARCH DENTAL - FRISCO5404 PRESTON RD STE 108 (972) 963-9104
Provider ID: 000583086 NPI Number: 1639249303
Page 1 of 5 July 2020Texas ConcordiaPLUS PDO
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasDirectory of Participating Dental Providers
ConcordiaPLUS PDO
LEWISVILLE - 75056General Dentist
MARSH RIDGE FAMILY DENTAL & ORTHODONTICS4920 STATE HIGHWAY 121 STE 200 (972) 300-4155
Provider ID: 003028107 NPI Number: 1205387909
LEWISVILLE - 75067General Dentist
MONARCH DENTAL - LEWISVILLE1288 W MAIN ST STE 123 (972) 221-2220
Provider ID: 001682838 NPI Number: 1639249303
LITTLE ELM - 75068General Dentist
MONARCH DENTAL - LITTLE ELM2700 E ELDORADO PKWY STE 106 (972) 987-4944
Provider ID: 002092529 NPI Number: 1639249303
THE COLONY - 75056General Dentist
MONARCH DENTAL - JOSEY LANE4770 STATE HIGHWAY 121 STE 100 (972) 963-9900
Provider ID: 002140047 NPI Number: 1639249303
EL PASO CountyEL PASO - 79912
Multi-Specialty
MONARCH DENTAL7040 N MESA ST STE A (915) 833-1800
Provider ID: 001528539 NPI Number: 1720158496
ELLIS CountyRED OAK - 75154
General Dentist
MONARCH DENTAL - RED OAK109 E OVILLA RD STE 400 (972) 617-0208
Provider ID: 001683102 NPI Number: 1639249303
WAXAHACHIE - 75165General Dentist
MONARCH DENTAL - WAXAHACHIE895 N HIGHWAY 77 STE 400 (972) 937-3501
Provider ID: 001580726 NPI Number: 1639249303
FORT BEND CountyKATY - 77494Multi-Specialty
LOVETT DENTAL1998 KATY MILLS BLVD STE D (832) 437-6477
Provider ID: 002620808 NPI Number: 1982900270
MISSOURI CITY - 77459General Dentist
CASTLE DENTAL - MISSOURI CITY6261 HIGHWAY 6 STE 400 (281) 969-1536
Provider ID: 002585038 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL6245 HIGHWAY 6 STE 400 (281) 969-5099
Provider ID: 002669237 NPI Number: 1427330596
RICHMOND - 77406General Dentist
CASTLE DENTAL - GRAND PARKWAY5614 W GRAND PKWY S STE 120 (832) 586-7075
Provider ID: 001683191 NPI Number: 1457421125
ROSENBERG - 77471General Dentist
CASTLE DENTAL - ROSENBERG24601 SOUTHWEST FWY STE 200 (281) 239-2010
Provider ID: 002085871 NPI Number: 1457421125
STAFFORD - 77477General Dentist
SOUTHERN DENTAL12800 FOUNTAIN LAKE CIR (281) 277-1609
Provider ID: 000579909 NPI Number: 1497128458
SUGAR LAND - 77479General Dentist
CASTLE DENTAL - SUGAR LAND2565 TOWN CENTER BLVD N (281) 494-4449
Provider ID: 001465133 NPI Number: 1457421125
Multi-Specialty
GMS DENTAL CENTERS OF EXCELLENCE16126 SOUTHWEST FWY STE 200 (281) 207-2770
Provider ID: 002124638 NPI Number: 1003037243
ROYAL DENTAL226 FLUOR DANIEL DR (281) 242-2040
Provider ID: 001629949 NPI Number: 1497890230
GALVESTON CountyLEAGUE CITY - 77573
General Dentist
CASTLE DENTAL - LEAGUE CITY2925 GULF FWY S STE D (281) 337-0313
Provider ID: 001988400 NPI Number: 1457421125
HARRIS CountyBAYTOWN - 77521
Multi-Specialty
LOVETT DENTAL6502 GARTH RD STE 100 (281) 838-8400
Provider ID: 002695885 NPI Number: 1841568789
ROYAL DENTAL6644 GARTH RD (281) 839-0532
Provider ID: 000572389 NPI Number: 1497890230
CHANNELVIEW - 77530Multi-Specialty
GMS DENTAL CENTERS OF EXCELLENCE15201 EAST FWY STE 225 (281) 457-2847
Provider ID: 002124635 NPI Number: 1003037243
CROSBY - 77532Multi-Specialty
TRINITY CROSBY DENTAL PLLC14045 FM 2100 RD STE 250 (281) 328-2222
Provider ID: 002726983 NPI Number: 1881962546
CYPRESS - 77429General Dentist
CASTLE DENTAL - CYPRESS25823 HIGHWAY 290 STE E (281) 373-5559
Provider ID: 001993291 NPI Number: 1457421125
HOUSTON - 77005Multi-Specialty
LOVETT DENTAL6137 KIRBY DR (713) 490-8888
Provider ID: 001391255 NPI Number: 1417067968
HOUSTON - 77007Multi-Specialty
LOVETT DENTAL174 YALE ST STE 1200 (832) 767-2210
Provider ID: 002727911 NPI Number: 1629346440
SAWYER HIGHTS DENTAL PLLC1919 TAYLOR ST STE 3A (713) 863-1520
SPLanguage(s):
Provider ID: 003340605 NPI Number: 1376948026
HOUSTON - 77008General Dentist
CASTLE DENTAL - NORTH SHEPHERD961 N SHEPHERD DR (281) 661-3529
Provider ID: 001580816 NPI Number: 1639249303
Multi-Specialty
GMS DENTAL CENTERS OF EXCELLENCE1445 NORTH LOOP W STE 1000 (713) 861-3231
Provider ID: 002113805 NPI Number: 1003037243
SOUTHERN DENTAL W 19TH310 W 19TH ST (713) 869-4085
Provider ID: 000579793 NPI Number: 1598138547
HOUSTON - 77013Multi-Specialty
TRINITY HOUSTON EAST DENTAL PLLC503 MAXEY RD (832) 804-6055
Provider ID: 003014201 NPI Number: 1992147474
HOUSTON - 77015Multi-Specialty
ROYAL DENTAL E FRWY12960 EAST FWY (713) 453-3559
Provider ID: 000572961 NPI Number: 1497890230
HOUSTON - 77017Multi-Specialty
ROYAL DENTAL8449 GULF FWY STE C (713) 649-8590
Provider ID: 000331876 NPI Number: 1497890230
HOUSTON - 77020Multi-Specialty
AMJAD A SHEIKH DDS PA7008 LYONS AVE (713) 674-0811
[
Provider ID: 002726959 NPI Number: 1851566129
HOUSTON - 77021General Dentist
SOUTHERN DENTAL MLK5703 MARTIN LUTHER KING BLVD (713) 644-6595
Provider ID: 000580243 NPI Number: 1912370974
Page 2 of 5 July 2020Texas ConcordiaPLUS PDO
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasDirectory of Participating Dental Providers
ConcordiaPLUS PDO
HOUSTON - 77022Multi-Specialty
LOVETT DENTAL4701 AIRLINE DR (713) 691-5551
Provider ID: 001934395 NPI Number: 1386865277
HOUSTON - 77027Multi-Specialty
SPLENDID DENTAL CARE & MY CHILDRENS DENTIS3991 RICHMOND AVE (713) 244-7797
Provider ID: 003814697 NPI Number: 1093256190
HOUSTON - 77035General Dentist
CASTLE DENTAL - POST OAK12341 MAIN ST (713) 729-9898
Provider ID: 001683201 NPI Number: 1457421125
HOUSTON - 77039Multi-Specialty
SHEIKH EASTEX DENTAL PA11939 EASTEX FWY STE I (281) 442-5500
Provider ID: 002726961 NPI Number: 1689994386
HOUSTON - 77040General Dentist
CASTLE DENTAL - NORTHWEST13486 NORTHWEST FWY (713) 460-4777
[
Provider ID: 001461908 NPI Number: 1457421125
HOUSTON - 77049Multi-Specialty
AMJAD A SHEIKH DDS PA5815 E SAM HOUSTON PKWY N STE C (281) 459-1555
Provider ID: 002726975 NPI Number: 1457618951
HOUSTON - 77054General Dentist
CASTLE DENTAL - FANNIN8132 KIRBY DR (713) 797-9041
[
Provider ID: 001544868 NPI Number: 1457421125
HOUSTON - 77055General Dentist
SOUTHERN DENTAL WIRT ROAD1459 WIRT RD (713) 932-1045
SPLanguage(s):
Provider ID: 000441045 NPI Number: 1023481082
HOUSTON - 77058General Dentist
CASTLE DENTAL - CLEARLAKE BAY AREA2321 BAY AREA BLVD (281) 480-9870
Provider ID: 001533290 NPI Number: 1457421125
HOUSTON - 77063General Dentist
CASTLE DENTAL - LAZY HOLLOW8571 WESTHEIMER RD STE C (713) 401-6230
Provider ID: 000833748 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL8570 WESTHEIMER RD (832) 242-2030
Provider ID: 001540065 NPI Number: 1720207897
HOUSTON - 77064Multi-Specialty
SOUTHERN DENTAL TOMBALL PKWY17776 STATE HIGHWAY 249 STE 20A (281) 469-0098
Provider ID: 000578710 NPI Number: 1013380070
HOUSTON - 77065General Dentist
CASTLE DENTAL - ELDRIDGE12246 FM 1960 RD W (281) 949-1001
[
Provider ID: 002100140 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL12711 FM 1960 RD W (281) 890-5002
Provider ID: 002045935 NPI Number: 1417118530
HOUSTON - 77069General Dentist
CASTLE DENTAL - CHAMPIONS5020 FM 1960 RD W STE B1 (281) 580-9058
Provider ID: 001529542 NPI Number: 1457421125
HOUSTON - 77070General Dentist
CASTLE DENTAL - COMPAQ21519 STATE HIGHWAY 249 STE H (281) 376-4848
Provider ID: 001580865 NPI Number: 1457421125
HOUSTON NORTHWEST DENTAL ASSOCIATES9631B FM 1960 RD W (281) 469-0589
EN, SPLanguage(s):
Provider ID: 000985998 NPI Number: 1982717922
Multi-Specialty
LOVETT DENTAL10123 LOUETTA RD STE 900 (832) 843-6776
Provider ID: 003065372 NPI Number: 1538588702
HOUSTON - 77074General Dentist
CHHEDA, HEMLATA N., DDS8191 SOUTHWEST FWY STE 111 (713) 988-3778
GU, HILanguage(s):
Provider ID: 000891448 NPI Number: 1467477935
HOUSTON - 77075General Dentist
CASTLE DENTAL - PEARLAND PARKWAY8501 S SAM HOUSTON PKWY E (713) 300-1470
Provider ID: 002526207 NPI Number: 1457421125
HOUSTON - 77082Multi-Specialty
LOVETT DENTAL3402 HIGHWAY 6 S STE C (281) 759-5900
Provider ID: 001762833 NPI Number: 1659592541
HOUSTON - 77083Multi-Specialty
ROYAL DENTAL HWY 6 SOUTH8145 HIGHWAY 6 S STE 130 (281) 498-8486
Provider ID: 000572482 NPI Number: 1497890230
HOUSTON - 77084General Dentist
CASTLE DENTAL - COPPERFIELD6831 HIGHWAY 6 N (281) 861-7054
Provider ID: 000582821 NPI Number: 1457421125
Multi-Specialty
ROYAL DENTAL HWY 6 NORTH5700 HIGHWAY 6 N STE 200 (281) 856-0999
EN, SPLanguage(s):
Provider ID: 000572425 NPI Number: 1497890230
HOUSTON - 77087Multi-Specialty
LOVETT DENTAL995 GULFGATE CENTER MALL (713) 847-8822
Provider ID: 001540053 NPI Number: 1568683456
HOUSTON - 77094Multi-Specialty
LOVETT DENTAL19961 KATY FWY (713) 244-7799
SPLanguage(s):
Provider ID: 003637789 NPI Number: 1568997021
HOUSTON - 77096Multi-Specialty
LOVETT DENTAL650 MEYERLAND PLAZA MALL (281) 974-3434
Provider ID: 003065395 NPI Number: 1598165094
HUMBLE - 77338General Dentist
CASTLE DENTAL - HUMBLE WEST9809 FM 1960 BYPASS RD W (281) 446-3855
Provider ID: 001581010 NPI Number: 1457421125
HUMBLE DENTAL ASSOCIATES9648 FM 1960 BYPASS RD W (281) 540-8100
Provider ID: 000778066 NPI Number: 1528171584
SOUTHERN DENTAL DEERBROOK MALL20131 HIGHWAY 59 N STE 1238 (281) 446-4237
Provider ID: 000581281 NPI Number: 1720462849
Multi-Specialty
LOVETT DENTAL20135 HIGHWAY 59 N STE A (281) 441-9000
[
Provider ID: 002141363 NPI Number: 1891920096
ROYAL DENTAL9952 FM 1960 BYPASS RD W (281) 358-6200
SPLanguage(s):
Provider ID: 002568528 NPI Number: 1497890230
HUMBLE - 77339General Dentist
BUTLER, KEVIN S., DDS3411 CEDAR KNOLLS DR (281) 358-7995
[
Provider ID: 000667045 NPI Number: 1245335462
HUMBLE - 77346Pediatric Dentist
SPLENDID DENTAL CARE7112 FM 1960 RD E (731) 244-7790
Provider ID: 003713376 NPI Number: 1396285110
Page 3 of 5 July 2020Texas ConcordiaPLUS PDO
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasDirectory of Participating Dental Providers
ConcordiaPLUS PDO
KATY - 77449Multi-Specialty
SOUTHERN DENTAL ASSOCIATES1215 FRY RD STE D (281) 398-1986
SPLanguage(s):
Provider ID: 001313084 NPI Number: 1235502287
KATY - 77450General Dentist
CASTLE DENTAL - MASON462 S MASON RD STE 200 (281) 395-3555
Provider ID: 001683197 NPI Number: 1457421125
Multi-Specialty
GMS DENTAL CENTERS OF EXCELLENCE20065 KATY FWY (281) 994-5050
Provider ID: 002124632 NPI Number: 1003037243
PASADENA - 77504General Dentist
CASTLE DENTAL - PASADENA SPENCER3570 SPENCER HWY (713) 947-9800
[
Provider ID: 001512503 NPI Number: 1457421125
PASADENA - 77505General Dentist
CASTLE DENTAL - PASADENA FAIRMONT5106 FAIRMONT PKWY (281) 487-1202
Provider ID: 001683196 NPI Number: 1457421125
SOUTHERN DENTAL PASADENA7219 FAIRMONT PKWY STE 100 (281) 487-3975
Provider ID: 000581340 NPI Number: 1134592199
SPRING - 77379General Dentist
TRAN, KHANH, DDS18425 CHAMPION FOREST DR STE 220 (281) 320-8709
SP, VTLanguage(s):
Provider ID: 000565441 NPI Number: 1144664871
SPRING - 77388General Dentist
CASTLE DENTAL - SPRING FM 29202129 FM 2920 RD STE 240 (281) 661-3530
Provider ID: 001683153 NPI Number: 1457421125
SPRING - 77389Multi-Specialty
SPLENDID DENTAL CARE2156 SPRING STUEBNER RD UNIT 510 (713) 587-9996
SPLanguage(s):
Provider ID: 003713361 NPI Number: 1942712377
TOMBALL - 77377Multi-Specialty
TRINITY TOMBALL DENTAL PLLC14215 FM 2920 RD STE 103 (832) 698-2989
SPLanguage(s):
Provider ID: 002726994 NPI Number: 1851657795
WALLER - 77484Multi-Specialty
WALLER DENTAL ASSOCIATES PA31315 FM 2920 RD STE 16A (936) 372-2673
HI, PO, SPLanguage(s):
Provider ID: 002683282 NPI Number: 1104129279
WEBSTER - 77598General Dentist
CASTLE DENTAL - CLEARLAKE NASA1020 W NASA PKWY STE 250 (281) 332-1366
Provider ID: 001465157 NPI Number: 1457421125
SOUTHERN DENTAL WEBSTER1249 W BAY AREA BLVD (281) 332-6099
Provider ID: 000578693 NPI Number: 1639553746
Multi-Specialty
LOVETT DENTAL304 W BAY AREA BLVD STE 300 (832) 932-5584
Provider ID: 002150634 NPI Number: 1912234469
JEFFERSON CountyBEAUMONT - 77706
Multi-Specialty
LOVETT DENTAL4105 DOWLEN RD STE A (409) 924-8100
[
Provider ID: 001391222 NPI Number: 1194946087
JOHNSON CountyBURLESON - 76028
General Dentist
MONARCH DENTAL - BURLESON140 NW JOHN JONES DR STE 120 (817) 426-3355
Provider ID: 001829017 NPI Number: 1639249303
Multi-Specialty
GREAT EXPRESSIONS DENTAL CENTERS OF TEXAS225 SE JOHN JONES DR STE 103 (817) 447-3535
Provider ID: 002890192 NPI Number: 1932420221
LIBERTY CountyCLEVELAND - 77327
Multi-Specialty
TRINITY CLEVELAND DENTAL PLLC106 TRULY PLZ (281) 592-2202
Provider ID: 002726992 NPI Number: 1114295862
MIDLAND CountyMIDLAND - 79705
Multi-Specialty
MONARCH DENTAL3303 N MIDKIFF RD STE 112 (432) 699-6222
Provider ID: 001604532 NPI Number: 1366512030
MONTGOMERY CountyCONROE - 77304
General Dentist
CASTLE DENTAL - CONROE1410 N LOOP 336 W (936) 441-0481
Provider ID: 001533261 NPI Number: 1457421125
TRINITY CONROE DENTAL PLLC1304 W DAVIS ST STE A (936) 228-1764
Provider ID: 003823914 NPI Number: 1063923654
Multi-Specialty
LOVETT DENTAL1317 W DAVIS ST STE D (936) 760-2400
Provider ID: 002564671 NPI Number: 1477862209
MAGNOLIA - 77354General Dentist
CASTLE DENTAL - MAGNOLIA6209 FM 1488 RD STE A (281) 789-3055
[
Provider ID: 001580813 NPI Number: 1457421125
PORTER - 77365Multi-Specialty
NORTH EAST HOUSTON DENTAL SPECIALIST PLLC23762 HIGHWAY 59 (281) 306-5194
Provider ID: 004167209 NPI Number: 1801378849
SPRING - 77380General Dentist
CASTLE DENTAL - WOODLANDS25114 GROGANS MILL RD STE D (281) 296-7600
Provider ID: 001453947 NPI Number: 1457421125
WOODLAND DENTAL PARTNERS25300 BOROUGH PARK DR STE A (281) 296-0052
Provider ID: 001563843 NPI Number: 1407969009
THE WOODLANDS - 77380Multi-Specialty
WOODLAND DENTAL CARE341 SAWDUST RD (281) 362-0005
EN, SPLanguage(s):
Provider ID: 000986004 NPI Number: 1114030160
ROCKWALL CountyROCKWALL - 75087
General Dentist
MONARCH DENTAL - ROWLETT2306 GREENCREST BLVD (972) 722-5500
Provider ID: 001682288 NPI Number: 1639249303
TARRANT CountyARLINGTON - 76011
General Dentist
MONARCH DENTAL - ARLINGTON/NORTH COLLINS 1005 N COLLINS ST STE 100 (817) 795-4044
Provider ID: 001683160 NPI Number: 1639249303
ARLINGTON - 76016General Dentist
MONARCH DENTAL - ARLINGTON/PLEASANT RIDGE 5760 W PLEASANT RDG RD STE 110 (817) 561-9199
Provider ID: 001683141 NPI Number: 1639249303
ARLINGTON - 76017General Dentist
TURNER, CECIL FREDERICK, DDS4050 W INTERSTATE 20 (817) 563-1111
Provider ID: 000789141 NPI Number: 1144238304
Page 4 of 5 July 2020Texas ConcordiaPLUS PDO
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasDirectory of Participating Dental Providers
ConcordiaPLUS PDO
BEDFORD - 76021General Dentist
MONARCH DENTAL - BEDFORD1717 AIRPORT FWY (817) 540-2223
Provider ID: 001683158 NPI Number: 1639249303
EULESS - 76039General Dentist
MONARCH DENTAL - EULESS SH1212721 STATE HIGHWAY 121 STE 300 (817) 786-3110
Provider ID: 001580817 NPI Number: 1639249303
FORT WORTH - 76104General Dentist
RUDDOCK, DWIGHT A., DDS719 HEMPHILL ST (817) 335-3806
ENLanguage(s):
Provider ID: 000789049 NPI Number: 1275546780
FORT WORTH - 76115General Dentist
MONARCH DENTAL - SEMINARY4200 SOUTH FWY STE 15 (817) 921-1554
Provider ID: 000868595 NPI Number: 1639249303
FORT WORTH - 76116General Dentist
MONARCH DENTAL - RIDGMAR1900 MALL CIR (817) 256-9823
Provider ID: 001683155 NPI Number: 1639249303
FORT WORTH - 76133General Dentist
MONARCH DENTAL - HULEN6261 GRANBURY RD (817) 346-9040
Provider ID: 001683098 NPI Number: 1639249303
FORT WORTH - 76135General Dentist
MONARCH DENTAL - LAKE WORTH6628 LAKE WORTH BLVD STE 200 (817) 238-7984
Provider ID: 001836341 NPI Number: 1639249303
HURST - 76053General Dentist
MONARCH DENTAL - HURST1101 MELBOURNE RD STE 2105 (817) 268-4867
Provider ID: 001434263 NPI Number: 1639249303
MANSFIELD - 76063General Dentist
MONARCH DENTAL - MANSFIELD101 W DEBBIE LN STE 106 (682) 518-5200
Provider ID: 001691732 NPI Number: 1639249303
Multi-Specialty
GREAT EXPRESSIONS DENTAL CENTERS OF TEXAS1551 HIGHWAY 287 N STE 411 (817) 453-6108
[
Provider ID: 002720498 NPI Number: 1811268659
NORTH RICHLAND HILLS - 76180General Dentist
MONARCH DENTAL - HILLTOP DR/RICHLAND HILLS6455 HILLTOP DR STE 114 (817) 577-3433
Provider ID: 001683108 NPI Number: 1639249303
NORTH RICHLAND HILLS - 76182General Dentist
MONARCH DENTAL - NORTH RICHLAND HILLS/DAVI8528 DAVIS BLVD STE 100 (817) 605-8067
Provider ID: 001757990 NPI Number: 1639249303
TRAVIS CountyAUSTIN - 78728
General Dentist
ADVANCED SMILE CENTER3407 WELLS BRANCH PKWY STE 700 (512) 244-7677
Provider ID: 000664735 NPI Number: 1104154251
Page 5 of 5 July 2020Texas ConcordiaPLUS PDO
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
Language Index
AF AFRIKAANS....... IN INDIAN....... TE TELUGU.......
AI ASIAN INDIAN....... IR IRANIAN....... TH THAI.......
AL ALBANIANS....... IT ITALIAN....... TK TURKISH.......
AM ARAMAIC....... JP JAPANESE....... TL TAMIL.......
AN ARMENIAN....... KA KANNADA....... TN TUNISIAN.......
AR ARABIC ....... KO KOREAN....... TO TOSK.......
AS ASSYRIAN....... KU KURDISH....... TU TURKMEN.......
AT AZERI TURKISH....... LA LATIN....... TW TAIWANESE.......
AU AZERBAIJANI TURKISH....... LB LEBANESE....... UK UKRAINIAN.......
AV AZERI....... LO LAOS....... UR URDU.......
AW AZARI....... LT LITHUANIAN....... UZ UZBEK.......
AZ AZERBAIJANI....... LV LATVIAN....... VS VISAYAN.......
BA BALOCHI....... MA MARATHI....... VT VIETNAMESE.......
BE BENGALI ....... MD MANDARIN....... YI YIDDISH.......
BL BULGARIAN....... MF MORE FOREIGN LANGUAGES....... YR YORUBA.......
BN BANTUSE....... MG MALAGASY.......
BR BERBERE....... MH MAHRATTI.......
BU BURMESE....... ML MALAYALAM.......
CA CASTILIAN....... MN MANIPURI.......
CL CATALAN ....... MY MALAY.......
CM CAMBODIAN....... NE NEPALISE .......
CN CHINESE....... NO NORWEGIAN.......
CO COORG....... PA PARATHI.......
CR CROATIAN....... PH PHILLIPINO.......
CT CANTONESE....... PI PASHTU.......
CZ CZECH....... PL POLISH.......
DA DARI....... PR PERSIAN .......
DN DANISH....... PS PASHAI.......
DT DUTCH....... PT PORTUGESE.......
EG EGYPTIAN....... PU PUNJABI.......
EI EAST INDIAN....... RM ROMANIAN .......
EN ENGLISH....... RS RUSSIAN.......
FA FARSI....... SA SWAMILIA.......
FI FINNISH....... SC SCOTTISH.......
FM FLEMISH ....... SE SETSWANA .......
FR FRENCH....... SG SINHALESE.......
FU FUKIEN CHINESE....... SH SHONA.......
GA GA....... SI SIGN LANGUAGE .......
GK GREEK....... SL SOUTH INDIAN.......
GL GAELIC....... SM SAMOAN.......
GR GERMAN....... SN SINDHI.......
GU GUJARATI....... SP SPANISH.......
HE HEBREW....... SR SERBIAN.......
HG HUNGARIAN....... SS SCANDANAVIAN.......
HI HINDI....... ST SANSKRIT.......
IB IBO....... SV SLOVAK.......
IC ICELANDIC....... SW SWEDISH.......
ID INDONESIAN/ORIYA ....... SY SYRIAN.......
IL ILOCANO....... TA PILIPINO/TAGALOG .......
TexasDirectory of Participating Dental Providers
ConcordiaPLUS Specialists
TEXASBEXAR County
SAN ANTONIO - 78212Oral Surgery
GORDON, MATHEW C., DDS235 E HILDEBRAND AVE (210) 824-4501
Provider ID: 000975234 NPI Number: 1265591382
SAN ANTONIO - 78232Oral Surgery
KAERCHER, RAYMOND W., DDS14500 SAN PEDRO AVE STE 102 (210) 491-0015
SPLanguage(s):
Provider ID: 001564632 NPI Number: 1336122886
BRAZORIA CountyPEARLAND - 77581
Multi-Specialty
LALJI DENTAL PC1921 N MAIN ST STE 115 (713) 330-7700
Provider ID: 003481561 NPI Number: 1497890230
PEARLAND - 77584Endodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC10645 BROADWAY ST STE 102 (713) 436-9416
Provider ID: 001532983 NPI Number: 1457421125
Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC10645 BROADWAY ST STE 102 (713) 436-9416
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
CASTLE DENTAL10645 BROADWAY ST STE 102 (713) 436-9416
Provider ID: 000789287 NPI Number: 1457421125
Pediatric Dentist
MODERN DENTAL PROFESSIONALS HOUSTON PC10645 BROADWAY ST STE 102 (713) 436-9416
Provider ID: 001533221 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC10645 BROADWAY ST STE 102 (713) 436-9416
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL11302 BROADWAY ST STE 104 (281) 416-5844
Provider ID: 002669579 NPI Number: 1386939213
COLLIN CountyALLEN - 75013
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR204 CENTRAL EXPY S STE 59 (972) 649-0039
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR204 CENTRAL EXPY S STE 59 (972) 649-0039
Provider ID: 001528066 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR204 CENTRAL EXPY S STE 59 (972) 649-0039
Provider ID: 001528076 NPI Number: 1639249303
MCKINNEY - 75070Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1720 N CENTRAL EXPY STE 130 (972) 547-6033
Provider ID: 001527588 NPI Number: 1639249303
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR8910 STATE HIGHWAY 121 STE 210 (214) 383-7676
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR8910 STATE HIGHWAY 121 STE 210 (214) 383-7676
Provider ID: 001528066 NPI Number: 1639249303
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1720 N CENTRAL EXPY STE 130 (972) 547-6033
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR8910 STATE HIGHWAY 121 STE 210 (214) 383-7676
Provider ID: 001661126 NPI Number: 1639249303
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1720 N CENTRAL EXPY STE 130 (972) 647-6033
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1720 N CENTRAL EXPY STE 130 (972) 547-6033
Provider ID: 001528076 NPI Number: 1639249303
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR8910 STATE HIGHWAY 121 STE 210 (214) 383-7676
Provider ID: 001528076 NPI Number: 1639249303
PLANO - 75093Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3516 PRESTON RD STE 600 (972) 612-0604
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3516 PRESTON RD STE 600 (972) 612-0553
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MONARCH DENTAL3516 PRESTON RD STE 600 (972) 612-0553
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3516 PRESTON RD STE 600 (972) 612-0553
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3516 PRESTON RD STE 600 (972) 612-0553
Provider ID: 001528076 NPI Number: 1639249303
DALLAS CountyCARROLLTON - 75006
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2540 OLD DENTON RD STE 188 (972) 446-1211
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2540 OLD DENTON RD STE 188 (972) 446-0742
Provider ID: 001528066 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2540 OLD DENTON RD STE 188 (972) 446-0742
Provider ID: 001528076 NPI Number: 1639249303
CEDAR HILL - 75104Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR420 E PLEASANT RUN RD STE 390 (972) 764-2600
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR420 E PLEASANT RUN RD STE 390 (972) 764-2600
Provider ID: 001528066 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR420 E PLEASANT RUN RD STE 390 (469) 272-9333
Provider ID: 001528076 NPI Number: 1639249303
COPPELL - 75019Oral Surgery
STEELE, JAMES D., DDS225 E STATE HIGHWAY 121 STE 150 (972) 315-3355
SPLanguage(s):
Provider ID: 000997310 NPI Number: 1053416610
DALLAS - 75206Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR5400 E MOCKINGBIRD LN STE 219 (214) 361-2227
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR5400 E MOCKINGBIRD LN STE 219 (214) 823-2618
Provider ID: 001528066 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR5400 E MOCKINGBIRD LN STE 219 (214) 361-2227
Provider ID: 001528076 NPI Number: 1639249303
DALLAS - 75218Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR9440 GARLAND RD STE 230 (214) 660-0040
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR9440 GARLAND RD STE 230 (214) 660-0040
Provider ID: 001528066 NPI Number: 1639249303
Page 1 of 10 July 2020Texas ConcordiaPLUS Specialists
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasDALLAS - 75218 (continued)
Directory of Participating Dental Providers
ConcordiaPLUS Specialists
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR9440 GARLAND RD STE 230 (214) 660-0040
Provider ID: 001528076 NPI Number: 1639249303
DALLAS - 75219Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4140 LEMMON AVE STE 290 (214) 599-0778
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4140 LEMMON AVE STE 290 (214) 599-0728
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4140 LEMMON AVE STE 290 (214) 599-0779
Provider ID: 001528066 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4140 LEMMON AVE STE 290 (214) 599-0778
Provider ID: 001528076 NPI Number: 1639249303
DALLAS - 75228Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR9310 E R L THORNTON FWY (214) 660-8997
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR9310 E R L THORNTON FWY STE 100 (214) 660-8997
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR9310 E R L THORNTON FWY STE 100 (214) 660-8997
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR9310 E R L THORNTON FWY STE 100 (214) 660-8997
Provider ID: 001528076 NPI Number: 1639249303
DALLAS - 75230Oral Surgery
MARSHALL JR., HAROLD O., DDS7777 FOREST LN STE B101 (972) 566-7622
SPLanguage(s):
Provider ID: 000589957 NPI Number: 1962483768
Periodontist
GOODMAN, CRAIG S., DDS5925 FOREST LN STE 310 (972) 233-1142
SPLanguage(s):
Provider ID: 000091501 NPI Number: 1285658005
DALLAS - 75237Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3235 W CAMP WISDOM RD (214) 331-1131
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3235 W CAMP WISDOM RD (214) 331-1131
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MONARCH DENTAL3235 W CAMP WISDOM RD (214) 331-1131
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3235 W CAMP WISDOM RD (214) 331-1131
Provider ID: 001528076 NPI Number: 1639249303
DALLAS - 75248Oral Surgery
MONARCH DENTAL7989 BELT LINE RD STE 90 (972) 702-9017
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR7989 BELT LINE RD STE 90 (972) 702-0007
Provider ID: 001528066 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR7989 BELT LINE RD STE 90 (972) 702-0007
Provider ID: 001528076 NPI Number: 1639249303
DALLAS - 75254Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR14400 DALLAS PKWY STE 200 (972) 720-8866
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR14400 DALLAS PKWY STE 200 (972) 720-8866
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR14400 DALLAS PKWY STE 200 (972) 720-8866
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR14400 DALLAS PKWY STE 200 (972) 720-8866
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR14400 DALLAS PKWY STE 200 (972) 720-8866
Provider ID: 001528076 NPI Number: 1639249303
DUNCANVILLE - 75116Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR201 N CEDAR RIDGE DR STE 101 (972) 709-9568
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR201 S CEDAR RIDGE DR (972) 709-9568
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR201 S CEDAR RIDGE DR STE 101 (972) 709-9568
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR201 N CEDAR RIDGE DR STE 101 (972) 709-9568
Provider ID: 001528076 NPI Number: 1639249303
GARLAND - 75041Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1101 W CENTERVILLE RD STE 200 (972) 864-0695
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1101 W CENTERVILLE RD STE 200 (972) 864-0695
Provider ID: 001528066 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1101 W CENTERVILLE RD STE 200 (972) 864-0695
Provider ID: 001528076 NPI Number: 1639249303
GARLAND - 75044Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3325 BELT LINE RD (972) 530-4885
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3325 BELT LINE RD (972) 530-4885
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3325 BELT LINE RD (972) 530-1222
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3325 BELT LINE RD (972) 530-4885
Provider ID: 001528076 NPI Number: 1639249303
GRAND PRAIRIE - 75052Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR594 W INTERSTATE 20 (972) 264-6507
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR594 W INTERSTATE 20 STE 205 (972) 264-6507
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR594 W INTERSTATE 20 (672) 264-6622
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR594 W INTERSTATE 20 (972) 264-6622
Provider ID: 001528076 NPI Number: 1639249303
Page 2 of 10 July 2020Texas ConcordiaPLUS Specialists
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasDirectory of Participating Dental Providers
ConcordiaPLUS Specialists
IRVING - 75062Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3401 W AIRPORT FWY STE 206 (972) 256-6700
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3401 W AIRPORT FWY STE 206 (972) 256-7427
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3401 W AIRPORT FWY STE 206 (972) 256-6700
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3401 W AIRPORT FWY STE 206 (972) 256-7427
Provider ID: 001528076 NPI Number: 1639249303
IRVING - 75063Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR7620 N MACARTHUR BLVD (972) 831-0993
Provider ID: 001528076 NPI Number: 1639249303
MESQUITE - 75150Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3501 TOWNE CROSSING BLVD STE 180 (972) 270-6646
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3501 TOWNE CROSSING BLVD STE 180 (972) 270-6646
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3501 TOWNE CROSSING BLVD STE 180 (972) 270-6646
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR3501 TOWNE CROSSING BLVD STE 180 (972) 270-6646
Provider ID: 001528076 NPI Number: 1639249303
RICHARDSON - 75081Oral Surgery
HILL, STEPHEN C., DDS1001 BUCKINGHAM RD STE 106 (972) 644-8500
Provider ID: 000639088 NPI Number: 1588754915
ROWLETT - 75088Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4305 LAKEVIEW PKWY STE 100 (972) 412-6937
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4305 LAKEVIEW PKWY STE 100 (972) 813-2500
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4305 LAKEVIEW PKWY STE 100 (972) 535-1485
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4305 LAKEVIEW PKWY STE 100 (972) 813-2500
Provider ID: 001528076 NPI Number: 1639249303
DENTON CountyDENTON - 76205
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2201 S INTERSTATE 35 E STE L21C (940) 387-1921
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2201 S INTERSTATE 35 E STE L21C (940) 387-1921
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2201 S INTERSTATE 35 E STE L21 (940) 387-1921
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MONARCH DENTAL2201 S INTERSTATE 35 E STE L21C (940) 387-1921
Provider ID: 001528076 NPI Number: 1639249303
DENTON - 76210Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR7650 S INTERSTATE 35 E STE 152 (940) 497-2252
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR7650 S INTERSTATE 35 E STE 152 (940) 497-2252
Provider ID: 001528066 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR7650 S INTERSTATE 35 E STE 152 (940) 497-2252
Provider ID: 001528076 NPI Number: 1639249303
FRISCO - 75034Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR5404 PRESTON RD STE 108 (972) 963-9104
Provider ID: 001527588 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR5404 PRESTON RD STE 108 (972) 963-9104
Provider ID: 001661126 NPI Number: 1639249303
LEWISVILLE - 75067Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1288 W MAIN ST STE 123 (972) 221-2220
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1288 W MAIN ST STE 123 (972) 436-4975
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1288 W MAIN ST STE 123 (972) 436-4975
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1288 W MAIN ST STE 123 (972) 436-4975
Provider ID: 001528076 NPI Number: 1639249303
LITTLE ELM - 75068Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2700 E ELDORADO PKWY STE 106 (972) 987-4944
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2700 E ELDORADO PKWY STE 106 (972) 987-4944
Provider ID: 001528076 NPI Number: 1639249303
THE COLONY - 75056Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4770 STATE HIGHWAY 121 STE 100 (972) 963-9900
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4770 STATE HIGHWAY 121 STE 100 (972) 963-9900
Provider ID: 001528066 NPI Number: 1639249303
EL PASO CountyEL PASO - 79912
Multi-Specialty
MONARCH DENTAL7040 N MESA ST STE A (915) 833-1800
Provider ID: 001528539 NPI Number: 1720158496
ELLIS CountyRED OAK - 75154
Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR109 E OVILLA RD STE 400 (972) 617-0208
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR109 E OVILLA RD STE 400 (972) 617-0208
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR109 E OVILLA RD STE 400 (972) 617-0208
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR109 E OVILLA RD STE 400 (972) 617-0208
Provider ID: 001661126 NPI Number: 1639249303
Page 3 of 10 July 2020Texas ConcordiaPLUS Specialists
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasRED OAK - 75154 (continued)
Directory of Participating Dental Providers
ConcordiaPLUS Specialists
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR109 W OVILLA RD STE 400 (972) 617-0208
Provider ID: 001528076 NPI Number: 1639249303
WAXAHACHIE - 75165Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR895 N HIGHWAY 77 STE 400 (972) 937-3501
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR895 N HIGHWAY 77 STE 400 (972) 937-2489
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR895 N HIGHWAY 77 STE 400 (972) 937-2489
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR895 N HIGHWAY 77 STE 400 (972) 937-3501
Provider ID: 001528076 NPI Number: 1639249303
FORT BEND CountyKATY - 77494
Oral Surgery
KATY PERIODONTOLOGY & ORAL SURGERY PLLC24437 KATY FWY STE 500 (281) 256-8400
Provider ID: 003142045 NPI Number: 1285039339
Multi-Specialty
CLEAR CHOICE ORTHODONTICS1260 PIN OAK RD STE 208 (281) 392-0888
Provider ID: 002055749 NPI Number: N/A
LOVETT DENTAL1998 KATY MILLS BLVD STE D (832) 437-6477
Provider ID: 002620808 NPI Number: 1982900270
MISSOURI CITY - 77459Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC6261 HIGHWAY 6 STE 300 (281) 969-1536
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC6261 HIGHWAY 6 STE 400 (281) 969-1536
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC6261 HIGHWAY 6 STE 300 (281) 969-1536
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL6245 HIGHWAY 6 STE 400 (281) 969-5099
Provider ID: 002669237 NPI Number: 1427330596
RICHMOND - 77406Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC5614 W GRAND PKWY S STE 120 (832) 586-7075
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC5614 W GRAND PKWY S STE 120 (832) 586-7075
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC5614 W GRAND PKWY S STE 120 (832) 586-7075
Provider ID: 000821580 NPI Number: 1457421125
ROSENBERG - 77471Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC24601 SOUTHWEST FWY STE 200 (281) 239-2010
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC24601 SOUTHWEST FWY STE 200 (281) 239-2010
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC24601 SOUTHWEST FWY STE 200 (281) 239-2010
Provider ID: 000821580 NPI Number: 1457421125
STAFFORD - 77477Multi-Specialty
SOUTHERN DENTAL SPECIALIST GROUP PLLC12800 FOUNTAIN LAKE CIR (281) 277-1609
Provider ID: 003414286 NPI Number: 1033580493
SUGAR LAND - 77478Oral Surgery
SUGARLAND ORAL AND MAXILLOFACIAL SURGERY15200 SOUTHWEST FWY STE 360 (281) 494-9433
CH, SPLanguage(s):
Provider ID: 001850223 NPI Number: N/A
Orthodontist
GREENBERG, LARRY Z., DDS15200 SOUTHWEST FWY STE 370 (281) 498-3700
Provider ID: 000343126 NPI Number: 1649457417
SUGAR LAND - 77479Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC2565 TOWN CENTER BLVD N (281) 494-4449
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC2565 TOWN CENTER BLVD N (281) 494-4449
Provider ID: 000789287 NPI Number: 1457421125
Pediatric Dentist
MODERN DENTAL PROFESSIONALS HOUSTON PC2565 TOWN CENTER BLVD N (281) 494-4449
Provider ID: 001533221 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC2565 TOWN CENTER BLVD N (281) 494-4449
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
GMS DENTAL CENTERS OF EXCELLENCE16126 SOUTHWEST FWY STE 200 (281) 207-2770
Provider ID: 002124638 NPI Number: 1003037243
ROYAL DENTAL226 FLUOR DANIEL DR (281) 242-2040
Provider ID: 001629949 NPI Number: 1497890230
GALVESTON CountyLEAGUE CITY - 77573
Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC2925 GULF FWY S (281) 337-0313
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC2925 GULF FWY S (281) 337-0313
Provider ID: 000789287 NPI Number: 1457421125
Pediatric Dentist
MODERN DENTAL PROFESSIONALS HOUSTON PC2925 GULF FWY S STE D (281) 337-0313
Provider ID: 001533221 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC2925 GULF FWY S (281) 337-0313
Provider ID: 000821580 NPI Number: 1457421125
HARRIS CountyBAYTOWN - 77521
Multi-Specialty
LOVETT DENTAL6502 GARTH RD STE 100 (281) 838-8400
Provider ID: 002695885 NPI Number: 1841568789
ROYAL DENTAL6644 GARTH RD (281) 839-0532
Provider ID: 000572389 NPI Number: 1497890230
CHANNELVIEW - 77530Multi-Specialty
GMS DENTAL CENTERS OF EXCELLENCE15201 EAST FWY STE 225 (281) 457-2847
Provider ID: 002124635 NPI Number: 1003037243
CROSBY - 77532Multi-Specialty
TRINITY CROSBY DENTAL PLLC14045 FM 2100 RD STE 250 (281) 328-2222
Provider ID: 002726983 NPI Number: 1881962546
CYPRESS - 77429Endodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC25823 HIGHWAY 290 (281) 373-5559
Provider ID: 001532983 NPI Number: 1457421125
Oral Surgery
CYPRESS ORAL & MAXILLOFACIAL SURGERY26321 NORTHWEST FWY STE 700 (281) 256-8400
Provider ID: 003090532 NPI Number: 1790047702
MODERN DENTAL PROFESSIONALS HOUSTON PC25823 HIGHWAY 290 (281) 373-3649
Provider ID: 000815603 NPI Number: 1457421125
Page 4 of 10 July 2020Texas ConcordiaPLUS Specialists
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasCYPRESS - 77429 (continued)
Directory of Participating Dental Providers
ConcordiaPLUS Specialists
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC25823 HIGHWAY 290 STE E (281) 373-5559
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC25823 HIGHWAY 290 (281) 373-3649
Provider ID: 000821580 NPI Number: 1457421125
HOUSTON - 77005Multi-Specialty
LOVETT DENTAL6137 KIRBY DR (713) 490-8888
Provider ID: 001391255 NPI Number: 1417067968
HOUSTON - 77007Multi-Specialty
LOVETT DENTAL174 YALE ST STE 1200 (832) 767-2210
Provider ID: 002727911 NPI Number: 1629346440
SAWYER HIGHTS DENTAL PLLC1919 TAYLOR ST STE 3A (713) 863-1520
SPLanguage(s):
Provider ID: 003340605 NPI Number: 1376948026
HOUSTON - 77008Endodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC961 N SHEPHERD DR (281) 661-3529
Provider ID: 001532983 NPI Number: 1457421125
Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC961 N SHEPHERD DR (281) 661-3529
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC961 N SHEPHERD DR (281) 661-3529
Provider ID: 000789287 NPI Number: 1457421125
Pediatric Dentist
MODERN DENTAL PROFESSIONALS HOUSTON PC961 N SHEPHERD DR (281) 661-3529
Provider ID: 001533221 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC961 N SHEPHERD DR (281) 661-3529
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
GMS DENTAL CENTERS OF EXCELLENCE1445 NORTH LOOP W STE 1000 (713) 861-3231
Provider ID: 002113805 NPI Number: 1003037243
SOUTHERN DENTAL SPECIALIST GROUP PLLC310 W 19TH ST (713) 861-6250
Provider ID: 003414272 NPI Number: 1033580493
SOUTHERN DENTAL W 19TH310 W 19TH ST (713) 869-4085
Provider ID: 000579793 NPI Number: 1598138547
HOUSTON - 77013Multi-Specialty
TRINITY HOUSTON EAST DENTAL PLLC503 MAXEY RD (832) 804-6055
Provider ID: 003014201 NPI Number: 1992147474
HOUSTON - 77015Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC12322 EAST FWY STE A (713) 453-8301
Provider ID: 000815603 NPI Number: 1457421125
Pediatric Dentist
MODERN DENTAL PROFESSIONALS HOUSTON PC12322 EAST FWY STE A (713) 453-8301
Provider ID: 001533221 NPI Number: 1457421125
Multi-Specialty
ROYAL DENTAL E FRWY12960 EAST FWY (713) 453-3559
Provider ID: 000572961 NPI Number: 1497890230
HOUSTON - 77017Multi-Specialty
ROYAL DENTAL8449 GULF FWY STE C (713) 649-8590
Provider ID: 000331876 NPI Number: 1497890230
HOUSTON - 77020Multi-Specialty
AMJAD A SHEIKH DDS PA7008 LYONS AVE (713) 674-0811
Provider ID: 002726959 NPI Number: 1851566129
HOUSTON - 77022Multi-Specialty
LOVETT DENTAL4701 AIRLINE DR (713) 691-5551
Provider ID: 001934395 NPI Number: 1386865277
HOUSTON - 77024Endodontist
ALAWADHI, SAUD A M, DDS791 TOWN AND COUNTRY BLVD STE 209 (713) 461-3636
AR, SPLanguage(s):
Provider ID: 001623335 NPI Number: 1073616272
HOUSTON - 77027Multi-Specialty
SPLENDID DENTAL CARE & MY CHILDRENS DENTIS3991 RICHMOND AVE (713) 244-7797
Provider ID: 003814697 NPI Number: 1093256190
HOUSTON - 77030Oral Surgery
REMEDIOS, BENITO L., DDS7505 MAIN ST STE 390 (713) 790-9474
SPLanguage(s):
Provider ID: 000970036 NPI Number: 1457361404
HOUSTON - 77035Oral Surgery
CASTLE DENTAL12341 MAIN ST (713) 729-9898
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC12341 MAIN ST (713) 729-9898
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC12341 MAIN ST (713) 729-9898
Provider ID: 000821580 NPI Number: 1457421125
HOUSTON - 77039Multi-Specialty
SHEIKH EASTEX DENTAL PA11939 EASTEX FWY STE I (281) 442-5500
Provider ID: 002726961 NPI Number: 1689994386
HOUSTON - 77040Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC13486 NORTHWEST FWY (713) 460-4777
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC13486 NORTHWEST FWY (713) 460-4777
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC13486 NORTHWEST FWY (713) 460-4777
Provider ID: 000821580 NPI Number: 1457421125
HOUSTON - 77044Oral Surgery
SUMMERWOOD ORAL SURGERY13057 W LAKE HOUSTON PKWY (832) 241-6100
Provider ID: 002880200 NPI Number: N/A
HOUSTON - 77049Multi-Specialty
AMJAD A SHEIKH DDS PA5815 E SAM HOUSTON PKWY N STE C (281) 459-1555
Provider ID: 002726975 NPI Number: 1457618951
HOUSTON - 77054Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC8132 KIRBY DR (713) 797-0267
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
HEATHER BROWN DDS PA2636 S LOOP W STE 100 (713) 665-4455
Provider ID: 002130634 NPI Number: 1477787406
MODERN DENTAL PROFESSIONALS HOUSTON PC8132 KIRBY DR (713) 797-0267
Provider ID: 000789287 NPI Number: 1457421125
Pediatric Dentist
MODERN DENTAL PROFESSIONALS HOUSTON PC8132 KIRBY DR (713) 797-9041
Provider ID: 001533221 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC8132 KIRBY DR (713) 797-0267
Provider ID: 000821580 NPI Number: 1457421125
Page 5 of 10 July 2020Texas ConcordiaPLUS Specialists
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasHOUSTON - 77054 (continued)
Directory of Participating Dental Providers
ConcordiaPLUS Specialists
Prosthodontist
MARRUFFO, JOANN P., DDS2600 S LOOP W STE 570 (713) 667-3300
SPLanguage(s):
Provider ID: 001899961 NPI Number: 1457496960
HOUSTON - 77058Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC2321 BAY AREA BLVD (281) 480-9870
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC2321 BAY AREA BLVD (281) 480-9870
Provider ID: 000789287 NPI Number: 1457421125
Pediatric Dentist
MODERN DENTAL PROFESSIONALS HOUSTON PC2321 BAY AREA BLVD (281) 480-9860
Provider ID: 001533221 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC2321 BAY AREA BLVD (281) 480-9870
Provider ID: 000821580 NPI Number: 1457421125
HOUSTON - 77063Endodontist
MAHNAZ MESSKOUB DDS MS PA9400 WESTHEIMER RD STE 1 (713) 932-7730
PR, SPLanguage(s):
Provider ID: 003696073 NPI Number: 1356564587
MODERN DENTAL PROFESSIONALS HOUSTON PC8571 WESTHEIMER RD STE C (713) 401-6230
Provider ID: 001532983 NPI Number: 1457421125
Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC8571 WESTHEIMER RD STE C (713) 401-6230
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC8571 WESTHEIMER RD STE C (713) 401-6230
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC8571 WESTHEIMER RD STE C (713) 401-6230
Provider ID: 000821580 NPI Number: 1457421125
TEXAS PERIODONTAL ASSOC7500 SAN FELIPE ST STE 325 (713) 457-6351
SPLanguage(s):
Provider ID: 001304981 NPI Number: N/A
Multi-Specialty
LOVETT DENTAL8570 WESTHEIMER RD (832) 242-2030
Provider ID: 001540065 NPI Number: 1720207897
HOUSTON - 77064Multi-Specialty
SOUTHERN DENTAL SPECIALIST GROUP PLLC17776 STATE HIGHWAY 249 STE 20A (281) 469-0097
Provider ID: 003414256 NPI Number: 1033580493
HOUSTON - 77065Endodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC12246 FM 1960 RD W (281) 949-1001
Provider ID: 001532983 NPI Number: 1457421125
Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC12246 FM 1960 RD W (281) 949-1001
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC12246 FM 1960 RD W (281) 949-1001
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC12246 FM 1960 RD W (281) 949-1001
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL12711 FM 1960 RD W (281) 890-5002
Provider ID: 002045935 NPI Number: 1417118530
HOUSTON - 77069Endodontist
MONARCH DENTAL5020 FM 1960 RD W STE B1 (281) 580-9058
Provider ID: 001532983 NPI Number: 1457421125
Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC5020 FM 1960 RD W STE B1 (281) 580-9058
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
CRIST, MICHAEL A., DDS13303 CHAMPION FOREST DR STE 10 (281) 895-7600
Provider ID: 000074553 NPI Number: 1013928233
MODERN DENTAL PROFESSIONALS HOUSTON PC5020 FM 1960 RD W STE B1 (281) 580-9058
Provider ID: 000789287 NPI Number: 1457421125
Pediatric Dentist
CASTLE DENTAL5020 CYPRESS CREEK PKWY STE B1 (281) 583-0888
Provider ID: 001533221 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC5020 FM 1960 RD W STE B1 (281) 580-9058
Provider ID: 000821580 NPI Number: 1457421125
HOUSTON - 77070Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC21519 STATE HIGHWAY 249 STE H (281) 376-4848
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC21519 STATE HIGHWAY 249 STE H (281) 376-4848
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
DASTOOR, SAROSH F., DMD12850 JONES RD STE 104 (281) 890-4867
GULanguage(s):
Provider ID: 002110099 NPI Number: 1942331392
MODERN DENTAL PROFESSIONALS HOUSTON PC21519 STATE HIGHWAY 249 STE H (281) 376-4848
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL10123 LOUETTA RD STE 900 (832) 843-6776
Provider ID: 003065372 NPI Number: 1538588702
HOUSTON - 77075Endodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC8501 S SAM HOUSTON PKWY E (713) 300-1407
Provider ID: 001532983 NPI Number: 1457421125
Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC8501 S SAM HOUSTON PKWY E D-110 (713) 300-1470
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC8501 S SAM HOUSTON PKWY E (713) 300-1470
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC8501 S SAM HOUSTON PKWY E (713) 300-1470
Provider ID: 000821580 NPI Number: 1457421125
HOUSTON - 77079Periodontist
SORDELLI, ALDO E., DDS1035 DAIRY ASHFORD RD STE 234 (281) 759-2929
EN, SPLanguage(s):
Provider ID: 000924491 NPI Number: 1225167596
HOUSTON - 77082Multi-Specialty
LOVETT DENTAL3402 HIGHWAY 6 S STE C (281) 759-5900
Provider ID: 001762833 NPI Number: 1659592541
HOUSTON - 77083Multi-Specialty
ROYAL DENTAL HWY 6 SOUTH8145 HIGHWAY 6 S STE 130 (281) 498-8486
Provider ID: 000572482 NPI Number: 1497890230
HOUSTON - 77084Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC6831 HIGHWAY 6 N (281) 861-7054
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC6831 HIGHWAY 6 N (281) 861-7054
Provider ID: 000789287 NPI Number: 1457421125
Page 6 of 10 July 2020Texas ConcordiaPLUS Specialists
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasHOUSTON - 77084 (continued)
Directory of Participating Dental Providers
ConcordiaPLUS Specialists
Pediatric Dentist
MODERN DENTAL PROFESSIONALS HOUSTON PC6831 HIGHWAY 6 N (281) 861-7054
Provider ID: 001533221 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC6831 HIGHWAY 6 N (281) 861-7345
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
ROYAL DENTAL HWY 6 NORTH5700 HIGHWAY 6 N STE 200 (281) 856-0999
EN, SPLanguage(s):
Provider ID: 000572425 NPI Number: 1497890230
HOUSTON - 77087Multi-Specialty
LOVETT DENTAL995 GULFGATE CENTER MALL (713) 847-8822
Provider ID: 001540053 NPI Number: 1568683456
HOUSTON - 77090Multi-Specialty
CLEAR CHOICE ORTHODONTICS112 BAMMEL WESTFIELD RD (281) 587-4900
Provider ID: 002055752 NPI Number: N/A
HOUSTON - 77094Multi-Specialty
LOVETT DENTAL19961 KATY FWY (713) 244-7799
SPLanguage(s):
Provider ID: 003637789 NPI Number: 1568997021
HOUSTON - 77096Periodontist
MEYERLAND PERIODONTAL ASSOC PLLC9660 HILLCROFT ST STE 353 (713) 283-9776
Provider ID: 001449530 NPI Number: N/A
Multi-Specialty
LOVETT DENTAL650 MEYERLAND PLAZA MALL (281) 974-3434
Provider ID: 003065395 NPI Number: 1598165094
HUMBLE - 77338Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC9809 FM 1960 BYPASS RD W (281) 446-3855
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC9809 FM 1960 BYPASS RD W (281) 446-3855
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC9809 FM 1960 BYPASS RD W (281) 446-3855
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL20135 HIGHWAY 59 N STE A (281) 441-9000
Provider ID: 002141363 NPI Number: 1891920096
ROYAL DENTAL9952 FM 1960 BYPASS RD W (281) 358-6200
SPLanguage(s):
Provider ID: 002568528 NPI Number: 1497890230
SOUTHERN DENTAL SPECIALIST GROUP PLLC20131 HIGHWAY 59 N STE 1238 (281) 446-4237
Provider ID: 003414285 NPI Number: 1033580493
HUMBLE - 77346Pediatric Dentist
SPLENDID DENTAL CARE7112 FM 1960 RD E (731) 244-7790
Provider ID: 003713376 NPI Number: 1396285110
KATY - 77449Multi-Specialty
SOUTHERN DENTAL ASSOCIATES1215 FRY RD STE D (281) 398-1986
SPLanguage(s):
Provider ID: 001313084 NPI Number: 1235502287
SOUTHERN DENTAL SPECIALIST GROUP PLLC1215 FRY RD STE D (281) 398-4132
Provider ID: 003414279 NPI Number: 1033580493
KATY - 77450Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC462 S MASON RD STE 200 (281) 395-3555
Provider ID: 000815603 NPI Number: 1457421125
WIGGINS, RAYMOND L., DDS810 S MASON RD STE 301 (281) 395-1200
Provider ID: 001503549 NPI Number: 1942297510
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC462 S MASON RD STE 200 (281) 395-3555
Provider ID: 000789287 NPI Number: 1457421125
Pediatric Dentist
WONG, CHUN YIN, DMD20065 KATY FWY (281) 994-5050
SPLanguage(s):
Provider ID: 004373094 NPI Number: 1982130233
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC462 S MASON RD STE 200 (281) 395-3555
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
GMS DENTAL CENTERS OF EXCELLENCE20065 KATY FWY (281) 994-5050
Provider ID: 002124632 NPI Number: 1003037243
KINGWOOD - 77339Orthodontist
PAIGE, SEBASTIAN Z., DDS23900 HIGHWAY 59 N (281) 358-6580
Provider ID: 002887723 NPI Number: 1932495132
PASADENA - 77504Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC3570 SPENCER HWY (713) 947-9800
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC3570 SPENCER HWY (713) 947-9800
Provider ID: 000789287 NPI Number: 1457421125
PASADENA - 77505Endodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC5106 FAIRMONT PKWY (281) 487-1202
Provider ID: 001532983 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC5106 FAIRMONT PKWY (281) 487-1225
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
CASTLE DENTAL5106 FAIRMONT PKWY (281) 487-1202
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
SOUTHERN DENTAL SPECIALIST GROUP PLLC7219 FAIRMONT PKWY STE 100 (281) 487-0318
Provider ID: 003422114 NPI Number: 1033580493
SPRING - 77379Orthodontist
MOHR, BRIAN A., DDS7623 LOUETTA RD STE 101 (281) 376-9670
ENLanguage(s):
Provider ID: 000479054 NPI Number: 1750557864
SPRING - 77388Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC2129 FM 2920 RD STE 240 (210) 928-2814
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
HAIDER, ZANE K., DMD2540 FM 2920 RD STE H (281) 937-2540
GR, HI, SP, URLanguage(s):
Provider ID: 003487170 NPI Number: 1275960023
MODERN DENTAL PROFESSIONALS HOUSTON PC2129 FM 2920 RD STE 240 (281) 661-3530
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC2129 FM 2920 RD STE 240 (210) 928-2814
Provider ID: 000821580 NPI Number: 1457421125
SPRING - 77389Multi-Specialty
SPLENDID DENTAL CARE2156 SPRING STUEBNER RD UNIT 510 (713) 587-9996
SPLanguage(s):
Provider ID: 003713361 NPI Number: 1942712377
TOMBALL - 77377Multi-Specialty
TRINITY TOMBALL DENTAL PLLC14215 FM 2920 RD STE 103 (832) 698-2989
SPLanguage(s):
Provider ID: 002726994 NPI Number: 1851657795
Page 7 of 10 July 2020Texas ConcordiaPLUS Specialists
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasDirectory of Participating Dental Providers
ConcordiaPLUS Specialists
WALLER - 77484Multi-Specialty
WALLER DENTAL ASSOCIATES PA31315 FM 2920 RD STE 16A (936) 372-2673
HI, PO, SPLanguage(s):
Provider ID: 002683282 NPI Number: 1104129279
WEBSTER - 77598Endodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC1020 W NASA PKWY STE 250 (281) 332-1366
Provider ID: 001532983 NPI Number: 1457421125
Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC1020 W NASA PKWY STE 250 (281) 332-1366
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC1020 W NASA PKWY STE 250 (281) 332-1366
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC1020 W NASA PKWY STE 250 (281) 332-1366
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL304 W BAY AREA BLVD STE 300 (832) 932-5584
Provider ID: 002150634 NPI Number: 1912234469
SOUTHERN DENTAL SPECIALIST GROUP PLLC1249 W BAY AREA BLVD (281) 554-6382
Provider ID: 003414277 NPI Number: 1033580493
SOUTHERN DENTAL WEBSTER1249 W BAY AREA BLVD (281) 332-6099
Provider ID: 000578693 NPI Number: 1639553746
JEFFERSON CountyBEAUMONT - 77706
Multi-Specialty
LOVETT DENTAL4105 DOWLEN RD STE A (409) 924-8100
Provider ID: 001391222 NPI Number: 1194946087
JOHNSON CountyBURLESON - 76028
Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR140 NW JOHN JONES DR STE 120 (817) 426-3355
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR140 NW JOHN JONES DR (817) 426-3355
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR140 NW JOHN JONES DR STE 120 (817) 426-3355
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR140 NW JOHN JONES DR STE 120 (817) 426-3355
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR140 NW JOHN JONES DR (817) 426-3355
Provider ID: 001528076 NPI Number: 1639249303
Multi-Specialty
GREAT EXPRESSIONS DENTAL CENTERS OF TEXAS225 SE JOHN JONES DR STE 103 (817) 447-3535
Provider ID: 002890192 NPI Number: 1932420221
LIBERTY CountyCLEVELAND - 77327
Multi-Specialty
TRINITY CLEVELAND DENTAL PLLC106 TRULY PLZ (281) 592-2202
Provider ID: 002726992 NPI Number: 1114295862
MCLENNAN CountyWACO - 76705Pediatric Dentist
FRANCIS, SUSAN G., DDS3200 BELLMEAD DR (254) 799-4000
Provider ID: 001365431 NPI Number: 1326125915
MIDLAND CountyMIDLAND - 79705
Multi-Specialty
MONARCH DENTAL3303 N MIDKIFF RD STE 112 (432) 699-6222
Provider ID: 001604532 NPI Number: 1366512030
MONTGOMERY CountyCONROE - 77304
Endodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC1410 N LOOP 336 W (936) 441-0481
Provider ID: 001532983 NPI Number: 1457421125
Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC1410A N LOOP 336 W (936) 441-0481
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
LEIKER, BRADLEY J., DDS1003 LONGMIRE RD (936) 756-1386
Provider ID: 000801504 NPI Number: 1235256579
MODERN DENTAL PROFESSIONALS HOUSTON PC1410 N LOOP 336 W (936) 441-0481
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC1410A N LOOP 336 W (936) 441-0481
Provider ID: 000821580 NPI Number: 1457421125
Multi-Specialty
LOVETT DENTAL1317 W DAVIS ST STE D (936) 760-2400
Provider ID: 002564671 NPI Number: 1477862209
CONROE - 77384Pediatric Dentist
ROJAS, LUZ M., DDS17450 ST LUKES WAY STE 260 (936) 231-8705
SPLanguage(s):
Provider ID: 002735674 NPI Number: 1437325891
MAGNOLIA - 77354Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC6209 FM 1488 RD STE A (281) 789-3055
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC6209 FM 1488 RD STE A (281) 789-3055
Provider ID: 000789287 NPI Number: 1457421125
MOURITSEN, DAVID A., DDS31311 FM 2978 RD STE 101 (281) 356-3636
SPLanguage(s):
Provider ID: 003375872 NPI Number: 1811239510
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC6209 FM 1488 RD STE A (210) 615-3626
Provider ID: 000821580 NPI Number: 1457421125
PORTER - 77365Periodontist
FARAJ, SAMER A., DDS23762 HIGHWAY 59 (281) 306-5194
Provider ID: 004167236 NPI Number: 1588006902
SPRING - 77380Endodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC25114 GROGANS MILL RD (281) 296-7600
Provider ID: 001532983 NPI Number: 1457421125
Oral Surgery
MODERN DENTAL PROFESSIONALS HOUSTON PC25114 GROGANS MILL RD (281) 296-7600
Provider ID: 000815603 NPI Number: 1457421125
Orthodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC25114 GROGANS MILL RD (281) 296-7600
Provider ID: 000789287 NPI Number: 1457421125
Periodontist
MODERN DENTAL PROFESSIONALS HOUSTON PC25114 GROGANS MILL RD (281) 296-7600
Provider ID: 000821580 NPI Number: 1457421125
SPRING - 77381Orthodontist
MARDAGA, WILLIAM J., DDS4850 W PANTHER CREEK DR STE 108 (281) 367-7775
Provider ID: 000135175 NPI Number: 1245329515
MOURITSEN, DAVID A., DDS4850 W PANTHER CREEK DR STE 108 (281) 367-7775
Provider ID: 003639476 NPI Number: 1811239510
Page 8 of 10 July 2020Texas ConcordiaPLUS Specialists
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasDirectory of Participating Dental Providers
ConcordiaPLUS Specialists
SPRING - 77386Orthodontist
MARDAGA, WILLIAM J., DDS2211 RAYFORD RD STE 117 (281) 367-2211
Provider ID: 002097643 NPI Number: 1245329515
MOURITSEN, DAVID A., DDS2211 RAYFORD RD STE 117 (281) 367-2211
SPLanguage(s):
Provider ID: 003375872 NPI Number: 1811239510
THE WOODLANDS - 77380Multi-Specialty
DENTAL SPECIALISTS OF THE WOODLANDS PLLC25300 BOROUGH PARK DR STE C (281) 296-7007
Provider ID: 003333354 NPI Number: 1578963518
THE WOODLANDS - 77382Orthodontist
FARLEY, NORMAN D., DDS8000 RESEARCH FOREST DR STE 150 (281) 292-4272
SPLanguage(s):
Provider ID: 000604368 NPI Number: 1174604748
Multi-Specialty
CLEAR CHOICE ORTHODONTICS10845 KUYKENDAHL RD STE 100 (281) 587-4900
SPLanguage(s):
Provider ID: 002060199 NPI Number: N/A
ROCKWALL CountyROCKWALL - 75087
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2306 GREENCREST BLVD (972) 722-5500
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2306 GREENCREST BLVD (972) 722-5500
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2306 GREENCREST BLVD (972) 722-5500
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2306 GREENCREST BLVD (972) 722-5500
Provider ID: 001528076 NPI Number: 1639249303
TARRANT CountyARLINGTON - 76011
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1005 N COLLINS ST STE 100 (817) 795-4044
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1005 N COLLINS ST STE 100 (817) 795-4044
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1005 N COLLINS ST STE 100 (817) 795-4044
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1005 N COLLINS ST STE 100 (817) 795-4044
Provider ID: 001528076 NPI Number: 1639249303
ARLINGTON - 76016Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR5760 W PLEASANT RDG RD STE 110 (817) 561-9199
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR5760 W PLEASANT RDG RD STE 110 (817) 561-9199
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR5760 W PLEASANT RDG RD STE 110 (817) 561-9198
Provider ID: 001528066 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR5760 W PLEASANT RDG RD STE 110 (817) 561-9198
Provider ID: 001528076 NPI Number: 1639249303
ARLINGTON - 76017Orthodontist
WONG, DEBBY H., DMD4050 W INTERSTATE 20 (817) 563-1111
CNLanguage(s):
Provider ID: 002651998 NPI Number: 1992940076
BEDFORD - 76021Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1717 AIRPORT FWY (817) 540-2223
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1717 AIRPORT FWY (817) 540-2223
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1717 AIRPORT FWY (817) 540-2223
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1717 AIRPORT FWY (817) 540-2223
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1717 AIRPORT FWY (817) 540-2223
Provider ID: 001528076 NPI Number: 1639249303
EULESS - 76039Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2721 STATE HIGHWAY 121 STE 300 (817) 786-3110
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2721 STATE HIGHWAY 121 STE 300 (817) 786-3110
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2721 STATE HIGHWAY 121 STE 300 (817) 786-3110
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR2721 STATE HIGHWAY 121 STE 300 (817) 786-3110
Provider ID: 001528076 NPI Number: 1639249303
FORT WORTH - 76107Orthodontist
PAULUS, WILLIAM G., DDS4901 BYERS AVE (817) 738-2163
SPLanguage(s):
Provider ID: 000987614 NPI Number: 1700909819
Periodontist
DANIEL JR., BENGE R., DDS3600 HULEN ST STE C4 (817) 737-2594
SPLanguage(s):
Provider ID: 000452105 NPI Number: 1164611463
FORT WORTH - 76109Oral Surgery
NEILL, MAX G., DDS4421 OAK PARK LN STE 101 (817) 927-1818
EN, SP, VTLanguage(s):
Provider ID: 000464938 NPI Number: 1538156658
Pediatric Dentist
PREECE CHURCH AND ASSOCIATES PEDIATRIC DE5700 EDWARDS RANCH RD STE 100 (817) 292-2004
SPLanguage(s):
Provider ID: 001654209 NPI Number: 1043754740
PREECE, GEORGE S., DDS5700 EDWARDS RANCH RD STE 100 (817) 292-2004
SPLanguage(s):
Provider ID: 000800697 NPI Number: 1245251362
FORT WORTH - 76115Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4200 SOUTH FWY STE 15 (817) 921-1554
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4200 SOUTH FWY STE 15 (817) 921-1554
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4200 SOUTH FWY STE 15 (817) 921-1554
Provider ID: 001528066 NPI Number: 1639249303
Page 9 of 10 July 2020Texas ConcordiaPLUS Specialists
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
TexasFORT WORTH - 76115 (continued)
Directory of Participating Dental Providers
ConcordiaPLUS Specialists
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4200 SOUTH FWY STE 15 (817) 921-1554
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR4200 SOUTH FWY STE 15 (817) 921-1554
Provider ID: 001528076 NPI Number: 1639249303
FORT WORTH - 76116Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1900 MALL CIR (817) 377-2228
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1900 MALL CIR (817) 377-2228
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1900 MALL CIR (817) 377-2228
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1900 MALL CIR (817) 377-2228
Provider ID: 001528076 NPI Number: 1639249303
FORT WORTH - 76133Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6261 GRANBURY RD (817) 346-9040
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6261 GRANBURY RD (817) 346-9040
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6261 GRANBURY RD (817) 346-9040
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6261 GRANBURY RD (817) 346-9040
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6261 GRANBURY RD (817) 346-9040
Provider ID: 001528076 NPI Number: 1639249303
FORT WORTH - 76135Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6628 LAKE WORTH BLVD STE 200 (817) 238-7984
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6628 LAKE WORTH BLVD STE 200 (817) 238-7984
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6628 LAKE WORTH BLVD STE 200 (817) 238-7984
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6628 LAKE WORTH BLVD STE 200 (817) 238-7984
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6628 LAKE WORTH BLVD STE 200 (817) 238-7984
Provider ID: 001528076 NPI Number: 1639249303
GRAPEVINE - 76051Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR306 S PARK BLVD (817) 251-2688
Provider ID: 001661126 NPI Number: 1639249303
HURST - 76053Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1101 MELBOURNE RD STE 7002 (817) 268-4867
Provider ID: 001527588 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR1101 MELBOURNE RD STE 2105 (817) 268-4867
Provider ID: 001528076 NPI Number: 1639249303
KELLER - 76244Pediatric Dentist
PREECE CHURCH AND ASSOCIATES PEDIATRIC DE4100 HERITAGE TRACE PKWY STE 100 (817) 741-6100
Provider ID: 001986544 NPI Number: 1043754740
MANSFIELD - 76063Endodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR101 W DEBBIE LN STE 106 (817) 779-3104
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR101 W DEBBIE LN STE 106 (682) 518-5200
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR101 W DEBBIE LN STE 106 (682) 518-5200
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR101 W DEBBIE LN STE 106 (682) 518-5200
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR101 W DEBBIE LN STE 106 (682) 518-5200
Provider ID: 001528076 NPI Number: 1639249303
Multi-Specialty
GREAT EXPRESSIONS DENTAL CENTERS OF TEXAS1551 HIGHWAY 287 N STE 411 (817) 453-6108
Provider ID: 002720498 NPI Number: 1811268659
NORTH RICHLAND HILLS - 76180Endodontist
MONARCH DENTAL6455 HILLTOP DR STE 114 (817) 577-3433
Provider ID: 001528052 NPI Number: 1639249303
Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6455 HILLTOP DR STE 114 (817) 577-3433
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6455 HILLTOP DR STE 114 (817) 577-3433
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6455 HILLTOP DR STE 114 (817) 577-3433
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR6455 HILLTOP DR STE 114 (817) 577-3433
Provider ID: 001528076 NPI Number: 1639249303
NORTH RICHLAND HILLS - 76182Oral Surgery
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR8528 DAVIS BLVD (817) 605-8067
Provider ID: 001527588 NPI Number: 1639249303
Orthodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR8528 DAVIS BLVD (817) 605-8067
Provider ID: 001528066 NPI Number: 1639249303
Pediatric Dentist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR8528 DAVIS BLVD STE 100 (217) 605-8067
Provider ID: 001661126 NPI Number: 1639249303
Periodontist
MODERN DENTAL PROFESSIONAL DALLAS/FT WOR8528 DAVIS BLVD STE 100 (817) 605-8067
Provider ID: 001528076 NPI Number: 1639249303
TRAVIS CountyAUSTIN - 78756
Oral Surgery
HORNE, RONALD D., DDS4306 MEDICAL PKWY STE 2 (512) 454-6744
SPLanguage(s):
Provider ID: 000884400 NPI Number: 1013061902
WEBB CountyLAREDO - 78041
Oral Surgery
SALAZAR, ROLANDO, DDS6419 POLARIS DR STE A3 (956) 795-1010
SPLanguage(s):
Provider ID: 001560884 NPI Number: 1871623389
TREVINO, CESAR, DDS6419 POLARIS DR STE A3 (956) 795-1010
SPLanguage(s):
Provider ID: 001440639 NPI Number: 1811027428
Page 10 of 10 July 2020Texas ConcordiaPLUS Specialists
Currently not accepting new patients.
This list of dental providers is subject to change. To confirm provider participation, please contact United Concordia (1-866-357-3304) or the provider. You may access an online directory at www.unitedconcordia.com
[
Language Index
AF AFRIKAANS....... IN INDIAN....... TE TELUGU.......
AI ASIAN INDIAN....... IR IRANIAN....... TH THAI.......
AL ALBANIANS....... IT ITALIAN....... TK TURKISH.......
AM ARAMAIC....... JP JAPANESE....... TL TAMIL.......
AN ARMENIAN....... KA KANNADA....... TN TUNISIAN.......
AR ARABIC ....... KO KOREAN....... TO TOSK.......
AS ASSYRIAN....... KU KURDISH....... TU TURKMEN.......
AT AZERI TURKISH....... LA LATIN....... TW TAIWANESE.......
AU AZERBAIJANI TURKISH....... LB LEBANESE....... UK UKRAINIAN.......
AV AZERI....... LO LAOS....... UR URDU.......
AW AZARI....... LT LITHUANIAN....... UZ UZBEK.......
AZ AZERBAIJANI....... LV LATVIAN....... VS VISAYAN.......
BA BALOCHI....... MA MARATHI....... VT VIETNAMESE.......
BE BENGALI ....... MD MANDARIN....... YI YIDDISH.......
BL BULGARIAN....... MF MORE FOREIGN LANGUAGES....... YR YORUBA.......
BN BANTUSE....... MG MALAGASY.......
BR BERBERE....... MH MAHRATTI.......
BU BURMESE....... ML MALAYALAM.......
CA CASTILIAN....... MN MANIPURI.......
CL CATALAN ....... MY MALAY.......
CM CAMBODIAN....... NE NEPALISE .......
CN CHINESE....... NO NORWEGIAN.......
CO COORG....... PA PARATHI.......
CR CROATIAN....... PH PHILLIPINO.......
CT CANTONESE....... PI PASHTU.......
CZ CZECH....... PL POLISH.......
DA DARI....... PR PERSIAN .......
DN DANISH....... PS PASHAI.......
DT DUTCH....... PT PORTUGESE.......
EG EGYPTIAN....... PU PUNJABI.......
EI EAST INDIAN....... RM ROMANIAN .......
EN ENGLISH....... RS RUSSIAN.......
FA FARSI....... SA SWAMILIA.......
FI FINNISH....... SC SCOTTISH.......
FM FLEMISH ....... SE SETSWANA .......
FR FRENCH....... SG SINHALESE.......
FU FUKIEN CHINESE....... SH SHONA.......
GA GA....... SI SIGN LANGUAGE .......
GK GREEK....... SL SOUTH INDIAN.......
GL GAELIC....... SM SAMOAN.......
GR GERMAN....... SN SINDHI.......
GU GUJARATI....... SP SPANISH.......
HE HEBREW....... SR SERBIAN.......
HG HUNGARIAN....... SS SCANDANAVIAN.......
HI HINDI....... ST SANSKRIT.......
IB IBO....... SV SLOVAK.......
IC ICELANDIC....... SW SWEDISH.......
ID INDONESIAN/ORIYA ....... SY SYRIAN.......
IL ILOCANO....... TA PILIPINO/TAGALOG .......