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General NPI Number Information
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NPI Number | 1538865712
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Entity Type | Organization
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Legal Business Name | MODERN DENTISTRY
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 7410 HULL STREET RD STE 101
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5834
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Country | US
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Telephone | 804-510-0433
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Fax |
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Provider Business Mailing Address
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Address Line | 7410 HULL STREET RD STE 101
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-5834
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Country | US
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Telephone | 804-510-0433
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KATHERINE ESTRADA
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Credential |
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Telephone | 703-606-1305
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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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