Organization
IAN E MODESTOW, DMD
Active
Other names
Modestow Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE KERSBERGEN (OFFICE MANAGER)
(413) 586-5887
Entity
Organization
Contact information
Practice address
190 NONOTUCK ST, SUITE 101, FLORENCE, MA 01062-1962
(413) 586-5887
(413) 584-9478
Mailing address
190 NONOTUCK ST, SUITE 101, FLORENCE, MA 01062-1962
(413) 586-5887
(413) 584-9478
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN20017
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN13648
BOARD OF REGISTRATION
MA
01
—
DN20017
BOARD OF REGISTRATION
MA
Enumeration date
07/21/2011
Last updated
07/21/2011
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