Provider Demographics
NPI:1275621641
Name:MODGIL, VIRINDER (DDS)
Entity Type:Individual
Prefix:
First Name:VIRINDER
Middle Name:
Last Name:MODGIL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 N PETERBORO ST
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-1154
Mailing Address - Country:US
Mailing Address - Phone:315-697-3535
Mailing Address - Fax:315-362-9026
Practice Address - Street 1:68 MAIN ST
Practice Address - Street 2:POB 436
Practice Address - City:CAMDEN
Practice Address - State:NY
Practice Address - Zip Code:13316-1338
Practice Address - Country:US
Practice Address - Phone:315-245-1445
Practice Address - Fax:315-362-9026
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0523541122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist