NPIMap

Organization Active NPI

Londry, Modlin, Tucker II DDS PLLC

  • Pediatric Dentistry
  • Winston-Salem, NC
National Provider Identifier
1700650371
Registry record updated Nov 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
LONDRY, MODLIN, TUCKER II DDS PLLC
Practice address
705 Coliseum Dr NW
Winston-Salem, NC 27106-5312
Phone
(336) 721-7921
Fax
(336) 721-2011
NPI assigned
Nov 14, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2023

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

Authorized official

Name
Jalonda Sweeney
Title
Credentialing Specialist
Phone
(704) 997-8878

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

705 Coliseum Dr NW
Winston-Salem, NC 27106-5312

Mailing address

19810 W Catawba Ave Ste A1
Cornelius, NC 28031-4056
Phone (704) 997-8878

Other names 1

  • Silas Creek Adult and Pediatric Dentistry Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1699920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1700650371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19810 W CATAWBA AVE STE A1",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314056",
            "telephone_number": "704-997-8878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 COLISEUM DR NW",
            "city": "WINSTON-SALEM",
            "state": "NC",
            "postal_code": "271065312",
            "telephone_number": "336-721-7921",
            "fax_number": "336-721-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONDRY, MODLIN, TUCKER II DDS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-14",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "SWEENEY",
        "authorized_official_first_name": "JALONDA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "704-997-8878"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Silas Creek Adult and Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Winston-Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.