Modestow, Ian E

Modestow, Ian E is an individual health care provider with primary practice located at 190 Nonotuck St Suite 103, Florence MA 01062-1911. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Modestow, Ian E can be contacted via phone (413) 586-5887.

Contact Information

Primary practice address
190 Nonotuck St Suite 103 Florence MA 01062-1911
Phone: (413) 586-5887
Fax: (413) 586-5978
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 20017 Massachusetts

Profile Details

NPI number 1053381178
LBN Legal business name Modestow, Ian E
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 23rd, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053381178 NPPES
Massachusetts Other 20017 MA DENTAL LICENSE
Massachusetts Other X11346 MA DENTAL LICENSE

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