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Provider Information for 1255632451



DR. TESSA M MODIRI DDS

Gender: FEMALE

Individual NPI: 1255632451

Calendar Last Updated: 2012-01-04

Details

Name Value
NPI 1255632451
Enumeration Date 2010-11-04
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 3105 EMMORTON RD STE 2A
ABINGDON, MD 21009-2582
United States

Phone: 410-569-3555 | Fax: 410-569-7749
View Map External Link
Primary Practice Address 3105 EMMORTON RD STE 2A
ABINGDON, MD 21009-2582
United States

Phone: 410-569-3555 | Fax: 410-569-7749
View Map External Link
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist MD 14504
Other Identifiers
Issuer State Number