Provider Demographics
NPI:1447792239
Name:RYAN LONDRY & DAVID MODLIN DDS, PLLC
Entity Type:Organization
Organization Name:RYAN LONDRY & DAVID MODLIN DDS, PLLC
Other - Org Name:DENVER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MODLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-595-4516
Mailing Address - Street 1:19824 W CATAWBA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4046
Mailing Address - Country:US
Mailing Address - Phone:704-987-9087
Mailing Address - Fax:704-987-9044
Practice Address - Street 1:2226 N HIGHWAY 16
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8254
Practice Address - Country:US
Practice Address - Phone:704-766-8944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty