Provider Demographics
NPI:1194857888
Name:MOLFETAS, MARIANTHI (DOCTOR OF DENTAL SUR)
Entity type:Individual
Prefix:DR
First Name:MARIANTHI
Middle Name:
Last Name:MOLFETAS
Suffix:
Gender:F
Credentials:DOCTOR OF DENTAL SUR
Other - Prefix:DR
Other - First Name:MARIANE
Other - Middle Name:
Other - Last Name:MOLFETAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOCTOR OF DENTAL SUR
Mailing Address - Street 1:615 W 176TH ST APT 2WF
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7821
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:615 W 176TH ST APT 2WF
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7821
Practice Address - Country:US
Practice Address - Phone:917-648-4689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01768161Medicaid