Individual
DR. MAYRA MODESTO-GARRIDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
266 HARRISTOWN RD, SUITE 102, GLEN ROCK, NJ 07452-3302
(201) 652-0400
(201) 447-5762
Mailing address
266 HARRISTOWN RD, SUITE 102, GLEN ROCK, NJ 07452-3302
(201) 652-0400
(201) 447-5762
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
22DI01825501
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0066028
—
NJ
05
—
6037704
—
NJ
01
—
898217
UNITED CONCORDIA
NJ
Enumeration date
12/15/2006
Last updated
03/16/2023
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