Provider Demographics
NPI:1568042539
Name:MODERN DENTAL INC
Entity Type:Organization
Organization Name:MODERN DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR, OWNER,
Authorized Official - Prefix:DR
Authorized Official - First Name:MAHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAAITA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-349-3290
Mailing Address - Street 1:41 SANDERSON RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2611
Mailing Address - Country:US
Mailing Address - Phone:401-349-3290
Mailing Address - Fax:401-349-3291
Practice Address - Street 1:41 SANDERSON RD STE 106
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2611
Practice Address - Country:US
Practice Address - Phone:401-349-3290
Practice Address - Fax:401-349-3291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental