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General NPI Number Information
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NPI Number | 1831913037
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Entity Type | Organization
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Legal Business Name | LONDRY, MODLIN, TUCKER V DDS PLLC
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Dates
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Enumeration Date | 11/13/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 6570 SHALLOWFORD RD STE 110
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City | LEWISVILLE
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State | NC
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Zip | 27023-8651
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Country | US
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Telephone | 704-997-8878
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Fax |
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Provider Business Mailing Address
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Address Line | 20311 CHARTWELL CENTER DR. PO BOX 2127
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City | CORNELIUS
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State | NC
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Zip | 28031
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | LISA TRAVIS
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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