Provider Demographics
NPI:1013329069
Name:LONDRY & MODLIN II DDS PLLC
Entity Type:Organization
Organization Name:LONDRY & MODLIN II DDS PLLC
Other - Org Name:CONOVER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONDRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-270-6096
Mailing Address - Street 1:816 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-2712
Mailing Address - Country:US
Mailing Address - Phone:828-465-1344
Mailing Address - Fax:
Practice Address - Street 1:816 1ST AVE S
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-2712
Practice Address - Country:US
Practice Address - Phone:828-465-1344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty