Provider Demographics
NPI:1043388952
Name:MODJESKI, CATHERINE PAULINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:PAULINE
Last Name:MODJESKI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23030 E CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5454
Mailing Address - Country:US
Mailing Address - Phone:831-600-3260
Mailing Address - Fax:831-466-9483
Practice Address - Street 1:1107 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2818
Practice Address - Country:US
Practice Address - Phone:831-600-3261
Practice Address - Fax:831-466-9483
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53686122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist