Provider Demographics
NPI:1588838825
Name:MODLIN, NATALYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALYA
Middle Name:
Last Name:MODLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26-06 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-3829
Mailing Address - Country:US
Mailing Address - Phone:201-797-2100
Mailing Address - Fax:201-797-4024
Practice Address - Street 1:26-06 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3829
Practice Address - Country:US
Practice Address - Phone:201-797-2100
Practice Address - Fax:201-797-4024
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1022181001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice