Provider Demographics
NPI:1225342512
Name:MODI DENTAL CORPORATION
Entity Type:Organization
Organization Name:MODI DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HITESHKUMAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-556-9696
Mailing Address - Street 1:1633 E HATCH RD STE H
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-5080
Mailing Address - Country:US
Mailing Address - Phone:209-556-9696
Mailing Address - Fax:
Practice Address - Street 1:1633 E HATCH RD STE H
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-5080
Practice Address - Country:US
Practice Address - Phone:209-556-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50494251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health