Provider Demographics
NPI:1821524844
Name:DAVID MODLIN & RYAN LONDRY DDS PLLC
Entity Type:Organization
Organization Name:DAVID MODLIN & RYAN LONDRY DDS PLLC
Other - Org Name:YORK DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LONDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-270-6096
Mailing Address - Street 1:19810 W CATAWBA AVE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4056
Mailing Address - Country:US
Mailing Address - Phone:704-997-8878
Mailing Address - Fax:704-987-9044
Practice Address - Street 1:1015 CREEKSIDE MEDICAL DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:SC
Practice Address - Zip Code:29745-8624
Practice Address - Country:US
Practice Address - Phone:803-219-2580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC89121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty