Provider Demographics
NPI:1114218427
Name:ALI MODIRI DDS PC
Entity Type:Organization
Organization Name:ALI MODIRI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MODIRI
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:917-658-5823
Mailing Address - Street 1:420 E 64TH ST APT W3F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7862
Mailing Address - Country:US
Mailing Address - Phone:917-658-5823
Mailing Address - Fax:
Practice Address - Street 1:44 STRAWBERRY HILL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2632
Practice Address - Country:US
Practice Address - Phone:203-504-5870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-21
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0502201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty