Ian E Modestow, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN20017 Issued in MA

Legal business name

IAN E MODESTOW, DMD

Doing business as

Modestow Family Dentistry

Practice address

190 Nonotuck St
Suite 101
Florence, MA 01062-1962

Phone

(413) 586-5887

Fax

(413) 584-9478

NPI assigned

Jul 21, 2011

Last updated

Jul 21, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Michelle Kersbergen

Title

Office Manager

Phone

(413) 586-5887

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Modestow Family Dentistry Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311206400000",
    "number": "1083902266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 NONOTUCK ST",
            "address_2": "SUITE 101",
            "city": "FLORENCE",
            "state": "MA",
            "postal_code": "010621962",
            "telephone_number": "413-586-5887",
            "fax_number": "413-584-9478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 NONOTUCK ST",
            "address_2": "SUITE 101",
            "city": "FLORENCE",
            "state": "MA",
            "postal_code": "010621962",
            "telephone_number": "413-586-5887",
            "fax_number": "413-584-9478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IAN E MODESTOW, DMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-21",
        "last_updated": "2011-07-21",
        "status": "A",
        "authorized_official_last_name": "KERSBERGEN",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "413-586-5887",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN20017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF REGISTRATION",
            "identifier": "DN13648",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF REGISTRATION",
            "identifier": "DN20017",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Modestow Family Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Edith Howe, PH.D.
• Raymond E. Hubbe, M.D.
• Margaret Lisle Hudson, D.C.
• Rubina Husain, RDN
• Yvonne Elaine Hutchinson, LMSW
• Colleen M Isabelle, OPTICIAN
• Crystal Rene Jackson, LCSW
• Nancy B Jessup, LICSW
• Joseph Deschene DMD LLC (Valley Kids Pediatric Dentistry)
• David R Kalman, M.D.

• General Practice Dentistry in Florence, MA
• Providers in Florence, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.