Provider Demographics
NPI:1285948091
Name:MOLLNER, BENJAMIN DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:DOUGLAS
Last Name:MOLLNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 CITADEL DR E
Mailing Address - Street 2:SUITE 313
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5314
Mailing Address - Country:US
Mailing Address - Phone:719-574-1741
Mailing Address - Fax:
Practice Address - Street 1:685 CITADEL DR E
Practice Address - Street 2:SUITE 313
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5314
Practice Address - Country:US
Practice Address - Phone:719-574-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice