Provider Demographics
NPI:1124086442
Name:VICK, MOLLYE (DDS)
Entity type:Individual
Prefix:
First Name:MOLLYE
Middle Name:
Last Name:VICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5641 POPLAR TENT RD
Mailing Address - Street 2:STE 203
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027
Mailing Address - Country:US
Mailing Address - Phone:704-793-4211
Mailing Address - Fax:704-793-4210
Practice Address - Street 1:5641 POPLAR TENT RD
Practice Address - Street 2:STE 203
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027
Practice Address - Country:US
Practice Address - Phone:704-793-4211
Practice Address - Fax:704-793-4210
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist