Provider Demographics
NPI:1952114076
Name:MODERN EQUITY PLLC
Entity type:Organization
Organization Name:MODERN EQUITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-460-1484
Mailing Address - Street 1:1265 N MILFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1018
Mailing Address - Country:US
Mailing Address - Phone:617-460-1484
Mailing Address - Fax:
Practice Address - Street 1:1265 N MILFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1018
Practice Address - Country:US
Practice Address - Phone:617-460-1484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental