MEDICARE: PARAG MODI DMD

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	122300000X	Dentist	30.022930	OH

General Provider Information

NPI Number	:	1336369214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARAG MODI DMD

Provider Business Mailing Address
First Line	:	912 CONIFER TRL
Second Line	:
City	:	SUGARCREEK TOWNSHIP
State	:	OH
Zip	:	45305-7531
Country	:	US
Telephone Number	:	732-379-2722
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 CONIFER TRL
Second Line	:
City	:	SUGARCREEK TOWNSHIP
State	:	OH
Zip	:	45305-7531
Country	:	US
Telephone Number	:	732-379-2722
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	04/12/2021

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Directions to “ PARAG MODI DMD” Practice Location

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