MEDICARE: MODERN DENTAL CONCEPTS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1144355959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN DENTAL CONCEPTS INC.

Provider Business Mailing Address
First Line	:	4817 MAHONING AVE NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-1430
Country	:	US
Telephone Number	:	330-847-6076
Fax Number	:	330-847-8072

Provider Business Practice Location Address
First Line	:	4817 MAHONING AVE NW
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44483-1430
Country	:	US
Telephone Number	:	330-847-6076
Fax Number	:	330-847-8072

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SERGIO NADLER I
Credential	:	DMD
Telephone Number	:	330-847-0676

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	08/22/2020

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