Individual
HARESH MODHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
15 COLLINS INDUSTRIAL WAY STE A, LAWRENCEVILLE, GA 30043-6029
(770) 962-3191
Mailing address
15 COLLINS INDUSTRIAL WAY STE A, LAWRENCEVILLE, GA 30043-6029
(770) 962-3191
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN015134
GA
1223G0001X
General Practice Dentistry
DN21377
FL
Other
Enumeration date
07/27/2015
Last updated
11/17/2017
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