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General NPI Number Information
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NPI Number | 1396363156
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Entity Type | Individual
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Provider Name | RIMA MODI DMD
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Gender | Female
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Dates
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Enumeration Date | 07/08/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 702 S WEBER RD UNIT 1509
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City | ROMEOVILLE
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State | IL
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Zip | 60446-3058
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Country | US
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Telephone | 512-514-3671
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Fax |
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Provider Business Mailing Address
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Address Line | 221 N WEBER RD
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City | BOLINGBROOK
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State | IL
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Zip | 60490-1508
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Country | US
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Telephone | 331-757-4181
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Fax |
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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 | 019.032782
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License Number State | IL
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