Individual
NISHIT R MODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
685 QUEEN ST, #3, SOUTHINGTON, CT 06489-1547
(860) 863-5831
Mailing address
685 QUEEN ST, #3, SOUTHINGTON, CT 06489-1547
(860) 863-5831
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
CT010581
CT
Other
Enumeration date
07/30/2009
Last updated
12/17/2012
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