Provider Demographics
NPI:1376601278
Name:MODI, HITSHKUMAR MANUBHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:HITSHKUMAR
Middle Name:MANUBHAI
Last Name:MODI
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 1:1360 ANDLEMAN CT
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-8685
Mailing Address - Country:US
Mailing Address - Phone:209-668-0673
Mailing Address - Fax:
Practice Address - Street 1:1160 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-5239
Practice Address - Country:US
Practice Address - Phone:209-624-5161
Practice Address - Fax:209-524-5168
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA504941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92150Medicare ID - Type UnspecifiedDENTICAL