MEDICARE: LONDRY & MODLIN IX DDS LLC

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	:	1477203461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONDRY & MODLIN IX DDS LLC

Provider Business Mailing Address
First Line	:	19810 W CATAWBA AVE # A1
Second Line	:
City	:	CORNELIUS
State	:	NC
Zip	:	28031-4056
Country	:	US
Telephone Number	:	704-997-8878
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29073-7759
Country	:	US
Telephone Number	:	803-785-9991
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF NETWORK RELATIONS
Name	:	MRS. JESSICA HUNTER
Credential	:
Telephone Number	:	704-780-4597

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	04/09/2026

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