NPIMap

Organization Active NPI

Londry & Modlin DDS PLLC

Doing business as Lakeside Dental

  • General Practice Dentistry
  • Cornelius, NC
National Provider Identifier
1679822456
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
LONDRY & MODLIN DDS PLLC
Doing business as
Lakeside Dental
Practice address
19824 W Catawba Ave
Suite B
Cornelius, NC 28031-4046
Phone
(704) 987-9087
Fax
(704) 987-9044
NPI assigned
Sep 7, 2012
Last updated
Sep 7, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

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

Authorized official

Name
Nichole Dimascio
Title
Office Manager
Phone
(704) 987-9087

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X Primary

Addresses

Primary practice location

19824 W Catawba Ave
Suite B
Cornelius, NC 28031-4046

Mailing address

19824 W Catawba Ave
Suite B
Cornelius, NC 28031-4046
Phone (704) 987-9087

Other names 1

  • Lakeside Dental Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346976000000",
    "number": "1679822456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19824 W CATAWBA AVE",
            "address_2": "SUITE B",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314046",
            "telephone_number": "704-987-9087",
            "fax_number": "704-987-9044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19824 W CATAWBA AVE",
            "address_2": "SUITE B",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314046",
            "telephone_number": "704-987-9087",
            "fax_number": "704-987-9044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONDRY & MODLIN DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-07",
        "last_updated": "2012-09-07",
        "status": "A",
        "authorized_official_last_name": "DIMASCIO",
        "authorized_official_first_name": "NICHOLE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "704-987-9087"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeside Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cornelius, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; 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.