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General NPI Number Information
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NPI Number | 1477203461
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Entity Type | Organization
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Legal Business Name | LONDRY & MODLIN IX DDS LLC
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 06/11/2024
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Provider Practice Location Address
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Address Line | 1825 S LAKE DR
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City | LEXINGTON
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State | SC
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Zip | 29073-7759
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Country | US
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Telephone | 803-785-9991
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Fax |
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Provider Business Mailing Address
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Address Line | 19810 W CATAWBA AVE # A1
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City | CORNELIUS
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State | NC
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Zip | 28031-4056
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Country | US
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Telephone | 704-997-8878
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MARY CHAFFIN
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Credential |
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Telephone | 704-997-8878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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