Provider Demographics
NPI:1790791655
Name:MODICA, ROSANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSANNE
Middle Name:
Last Name:MODICA
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 1:150 MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2930
Mailing Address - Country:US
Mailing Address - Phone:716-634-1333
Mailing Address - Fax:716-634-6828
Practice Address - Street 1:150 MAPLE RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2930
Practice Address - Country:US
Practice Address - Phone:716-634-1333
Practice Address - Fax:716-634-6828
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0436531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice