Healthcare Provider Details

I. General information

NPI: 1013329069
Provider Name (Legal Business Name): LONDRY & MODLIN II DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 05/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 1ST AVE S
CONOVER NC
28613-2712
US

IV. Provider business mailing address

816 1ST AVE S
CONOVER NC
28613-2712
US

V. Phone/Fax

Practice location:
  • Phone: 828-465-1344
  • Fax:
Mailing address:
  • Phone: 828-465-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. RYAN LONDRY
Title or Position: OWNER/OPERATOR
Credential: DDS
Phone: 919-270-6096