Provider Demographics
NPI:1063437853
Name:MOLNAR, GEORGETTA
Entity type:Individual
Prefix:
First Name:GEORGETTA
Middle Name:
Last Name:MOLNAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 S. CENTRAL VALLEY HWY
Mailing Address - Street 2:P.O. BOX 1060
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-1060
Mailing Address - Country:US
Mailing Address - Phone:661-459-1900
Mailing Address - Fax:661-459-1974
Practice Address - Street 1:2101 7TH ST
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280
Practice Address - Country:US
Practice Address - Phone:661-758-5903
Practice Address - Fax:661-758-6630
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA3352807122300000X
CA47027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist