Provider Demographics
NPI:1477566859
Name:MODESTE, LORENZO JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:JOSEPH
Last Name:MODESTE
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 1:2238 TODDS LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3159
Mailing Address - Country:US
Mailing Address - Phone:757-825-6098
Mailing Address - Fax:757-826-5222
Practice Address - Street 1:2238 TODDS LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3159
Practice Address - Country:US
Practice Address - Phone:757-825-6098
Practice Address - Fax:757-826-5222
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010079281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice