Provider Demographics
NPI:1194122135
Name:MOLIND, SAMUEL EDWARD (DMD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:EDWARD
Last Name:MOLIND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1704
Mailing Address - Country:US
Mailing Address - Phone:423-652-0260
Mailing Address - Fax:423-652-0694
Practice Address - Street 1:210 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1704
Practice Address - Country:US
Practice Address - Phone:423-652-0260
Practice Address - Fax:423-652-0694
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN082221223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery