Healthcare Provider Details

I. General information

NPI: 1841082419
Provider Name (Legal Business Name): NADIM MODI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7065 S STATE ST
MIDVALE UT
84047-1555
US

IV. Provider business mailing address

3717 W PERIWINKLE DR
SOUTH JORDAN UT
84095-5114
US

V. Phone/Fax

Practice location:
  • Phone: 801-997-6884
  • Fax:
Mailing address:
  • Phone: 813-508-6397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: