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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
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 122300000X - Dentist MD 14504