Provider Demographics
NPI:1386348100
Name:HATALA, MOLLY (DDS)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:HATALA
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 1:933 UNIVERSITY AVE APT 329
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-4804
Mailing Address - Country:US
Mailing Address - Phone:607-765-6364
Mailing Address - Fax:
Practice Address - Street 1:3220 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5412
Practice Address - Country:US
Practice Address - Phone:585-889-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY064002-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist