Provider Demographics
NPI:1881933638
Name:MODLIN & LONDRY DDS PA
Entity type:Organization
Organization Name:MODLIN & LONDRY DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-549-1911
Mailing Address - Street 1:8732 UNIVERSITY CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-3558
Mailing Address - Country:US
Mailing Address - Phone:704-549-1911
Mailing Address - Fax:
Practice Address - Street 1:8732 UNIVERSITY CITY BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-3558
Practice Address - Country:US
Practice Address - Phone:704-549-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty