Organization
SHATORYA ANN MODKINS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SHATORYA ANN MODKINS (CEO)
(214) 208-6402
Entity
Organization
Contact information
Practice address
4342 LASHLEY DR, DALLAS, TX 75232-1186
(214) 208-6402
Mailing address
4342 LASHLEY DR, DALLAS, TX 75232-1186
(214) 208-6402
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
—
TX
Other
Enumeration date
01/15/2009
Last updated
01/15/2009
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