Provider Demographics
NPI:1114809027
Name:MODIANO DENTAL LLC
Entity type:Organization
Organization Name:MODIANO DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHANASIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:205-999-9527
Mailing Address - Street 1:1123 SE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-4701
Mailing Address - Country:US
Mailing Address - Phone:352-494-1153
Mailing Address - Fax:
Practice Address - Street 1:7586 SW 61ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-8310
Practice Address - Country:US
Practice Address - Phone:352-840-7077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental