Provider Demographics
NPI:1194888099
Name:MOLONY, MICHAEL E (DMD PSC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:E
Last Name:MOLONY
Suffix:
Gender:M
Credentials:DMD PSC
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:E
Other - Last Name:MOLONY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD PSC
Mailing Address - Street 1:2220 GRANDVIEW DRIVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-344-0400
Mailing Address - Fax:859-344-8980
Practice Address - Street 1:2220 GRANDVIEW DRIVE
Practice Address - Street 2:SUITE 240
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-344-0400
Practice Address - Fax:859-344-8980
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY501030OtherUNITED CONCORDIA
KY60044583Medicaid