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General NPI Number Information
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NPI Number | 1689074346
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Entity Type | Individual
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Provider Name | NISHA MODI DMD
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Gender | Female
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Dates
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Enumeration Date | 09/01/2014
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 1001 S HIGHWAY 377 107
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City | AUBREY
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State | TX
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Zip | 76227
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Country | US
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Telephone | 469-346-6612
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Fax |
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Provider Business Mailing Address
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Address Line | 8628 FOREST GLEN DR
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City | IRVING
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State | TX
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Zip | 75063-4201
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Country | US
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Telephone | 214-864-6515
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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 | 30422
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License Number State | TX
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