Reena Raman Modjeski, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019.033077 Issued in IL

Practice address

66 Green Acres Dr
Morris, IL 60450-3311

Phone

(815) 318-2012

Fax

(815) 318-2013

NPI assigned

May 26, 2021

Last updated

Apr 1, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Il Judge Dental PC

  • General Practice Dentistry
  • Woodstock, IL
  • NPI 1558515791
  NPD (past)

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

{
    "created_epoch": "1621987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1154996569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3977 SHOEGER DR",
            "city": "YORKVILLE",
            "state": "IL",
            "postal_code": "605605107",
            "telephone_number": "630-270-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 GREEN ACRES DR",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604503311",
            "telephone_number": "815-318-2012",
            "fax_number": "815-318-2013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODJESKI",
        "first_name": "REENA",
        "middle_name": "RAMAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-26",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019.033077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Kristina Miller, APN
• Mind Over Matter Psychotherapy P.C.
• Mindful Psychiatric Services, MDSC
• Michelle Lee Mitchell, N.C.
• Hatimali Imtiaz Husain Mithaiwala, DDS
• Morris Audiology Inc.
• Morris Comm HS Dist 101
• Morris Eyecare Associates Inc
• Morris Fire Protection & Ambulance District
• Morris Healthcare & Rehabilitation Center LLC (Morris Healthcare & Rehabilitation Center)

• General Practice Dentistry in Morris, IL
• Providers in Morris, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; 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.