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:
Health care specialties
| Specialty | Code | License # | 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 19 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053381178 | NPPES |
| Massachusetts | Other | 20017 | MA DENTAL LICENSE |
| Massachusetts | Other | X11346 | MA DENTAL LICENSE |
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