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General NPI Number Information
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NPI Number | 1720287865
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Entity Type | Organization
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Legal Business Name | TEJAS MODI D.D.S. INC.,
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 28039 SCOTT RD STE I
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City | MURRIETA
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State | CA
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Zip | 92563-7430
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Country | US
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Telephone | 951-246-8000
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Fax | 951-246-8002
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Provider Business Mailing Address
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Address Line | 28039 SCOTT RD STE I
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City | MURRIETA
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State | CA
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Zip | 92563-7430
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Country | US
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Telephone | 951-246-8000
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Fax | 951-246-8002
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Authorized Official
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Title or Position | PRESIDENT
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Name | TEJAS MODI
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Credential |
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Telephone | 951-246-8000
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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 | D47131
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License Number State | CA
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