Healthcare Provider Details

I. General information

NPI: 1639094527
Provider Name (Legal Business Name): ISHANI A MODI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 SPRING VALLEY RD
LANCASTER PA
17601-2427
US

IV. Provider business mailing address

204 BUTLER AVE STE 102
LANCASTER PA
17601-6307
US

V. Phone/Fax

Practice location:
  • Phone: 717-481-7645
  • Fax:
Mailing address:
  • Phone: 717-481-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS046058
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: