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General NPI Number Information
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NPI Number | 1043388952
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Entity Type | Individual
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Provider Name | CATHERINE PAULINE MODJESKI D.D.S
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Gender | Female
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1107 OCEAN ST
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City | SANTA CRUZ
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State | CA
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Zip | 95060-2818
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Country | US
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Telephone | 831-600-3261
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Fax | 831-466-9483
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Provider Business Mailing Address
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Address Line | 23030 E CLIFF DR
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City | SANTA CRUZ
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State | CA
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Zip | 95062-5454
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Country | US
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Telephone | 831-600-3260
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Fax | 831-466-9483
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 53686
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License Number State | CA
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