Organization
DANIELA MODESTO GRAN DENTAL INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIELA MODESTO DDS (DENTIST/PRESIDENT)
(954) 554-3490
Entity
Organization
Contact information
Practice address
2500 E COMMERCIAL BLVD, SUITE E, FORT LAUDERDALE, FL 33308-4124
(954) 662-7447
Mailing address
1000 PARKVIEW DR APT 720, HALLANDALE BEACH, FL 33009-2932
(954) 554-3490
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
DN 17097
FL
1223G0001X
General Practice Dentistry
Primary
DN17097
FL
Other
Enumeration date
04/03/2013
Last updated
04/03/2013
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