Provider Demographics
NPI:1154996569
Name:MODJESKI, REENA RAMAN (DMD)
Entity type:Individual
Prefix:DR
First Name:REENA
Middle Name:RAMAN
Last Name:MODJESKI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3977 SHOEGER DR
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-5107
Mailing Address - Country:US
Mailing Address - Phone:630-270-8530
Mailing Address - Fax:
Practice Address - Street 1:66 GREEN ACRES DR
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3311
Practice Address - Country:US
Practice Address - Phone:815-318-2012
Practice Address - Fax:815-318-2013
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0330771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice