Provider Demographics
NPI:1932308079
Name:MODI AND SHAH D.D.S. INC.,
Entity Type:Organization
Organization Name:MODI AND SHAH D.D.S. INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEJAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-246-8000
Mailing Address - Street 1:28039 SCOTT RD STE I
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-7430
Mailing Address - Country:US
Mailing Address - Phone:951-246-8000
Mailing Address - Fax:951-246-8002
Practice Address - Street 1:28039 SCOTT RD STE I
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7430
Practice Address - Country:US
Practice Address - Phone:951-246-8000
Practice Address - Fax:951-246-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD47131122300000X
CAD50823122300000X
CAD431821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty