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General NPI Number Information
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NPI Number | 1174466874
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Entity Type | Organization
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Legal Business Name | MODLIN & LONDRY XVII DDS PLLC
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Dates
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Enumeration Date | 04/09/2026
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 203 BOULEVARD ST
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City | HIGH POINT
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State | NC
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Zip | 27262-4301
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Country | US
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Telephone | 336-889-5466
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Fax | 336-889-6898
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Provider Business Mailing Address
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Address Line | 19810 W CATAWBA AVE STE C
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City | CORNELIUS
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State | NC
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Zip | 28031-4057
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Country | US
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Telephone | 704-780-4597
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF NETWORK RELATIONS
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Name | JESSICA HUNTER
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Credential |
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Telephone | 704-780-4597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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