MEDICARE: DR. JUSTIN MODUGNO DDS

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	RES.3620	OH
2	122300000X	Dentist	30-024466	OH

General Provider Information

NPI Number	:	1346623147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN MODUGNO DDS

Provider Business Mailing Address
First Line	:	8340 CLEVELAND AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4820
Country	:	US
Telephone Number	:	330-494-6305
Fax Number	:

Provider Business Practice Location Address
First Line	:	8340 CLEVELAND AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4820
Country	:	US
Telephone Number	:	330-494-6305
Fax Number	:

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

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	03/18/2025

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