Healthcare Provider Details

I. General information

NPI: 1659034411
Provider Name (Legal Business Name): MODLIN & LONDRY VIII DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 PARKWOOD MEDICAL PARK
ELKIN NC
28621-2444
US

IV. Provider business mailing address

19810 W CATAWBA AVE # A1
CORNELIUS NC
28031-4056
US

V. Phone/Fax

Practice location:
  • Phone: 336-835-7113
  • Fax:
Mailing address:
  • Phone: 704-997-8878
  • 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: MRS. LISA KAY TRAVIS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 828-850-4316