Individual
ALI MODIRI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
44 STRAWBERRY HILL AVE STE 1, STAMFORD, CT 06902-2632
(917) 658-5863
Mailing address
44 STRAWBERRY HILL AVE STE 1, STAMFORD, CT 06902-2632
(917) 658-5863
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
009363
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002093631
—
CT
05
—
1700868973
—
CT
Enumeration date
11/15/2005
Last updated
04/11/2013
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