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General NPI Number Information
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NPI Number | 1114809027
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Entity Type | Organization
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Legal Business Name | MODIANO DENTAL LLC
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 7586 SW 61ST AVE
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City | OCALA
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State | FL
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Zip | 34476-8310
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Country | US
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Telephone | 352-840-7077
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Fax |
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Provider Business Mailing Address
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Address Line | 1123 SE 45TH ST
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City | OCALA
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State | FL
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Zip | 34480-4701
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Country | US
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Telephone | 352-494-1153
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ATHANASIOS KOKKAS
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Credential | DDS
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Telephone | 205-999-9527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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