Healthcare Provider Details

I. General information

NPI: 1881564458
Provider Name (Legal Business Name): LONDRY & MODLIN XVIII DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3809 FORRESTGATE DR STE A
WINSTON SALEM NC
27103-2982
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 743-255-8011
  • Fax:
Mailing address:
  • Phone: 743-255-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: JESSICA HUNTER
Title or Position: DIRECTOR OF NETWORK RELATIONS
Credential:
Phone: 704-780-4597