Provider Demographics
NPI:1790805281
Name:MODERN DENTAL STUDIO, P.C.
Entity Type:Organization
Organization Name:MODERN DENTAL STUDIO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRIPTHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:732-432-0123
Mailing Address - Street 1:577 CRANBURY RD SUITE C-1
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5403
Mailing Address - Country:US
Mailing Address - Phone:732-432-0123
Mailing Address - Fax:732-432-7979
Practice Address - Street 1:577 CRANBURY RD SUITE C-1
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5403
Practice Address - Country:US
Practice Address - Phone:732-432-0123
Practice Address - Fax:732-432-7979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty