Provider Demographics
NPI:1396088290
Name:VALLI, MOLLY HARRISON (DMD)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:HARRISON
Last Name:VALLI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MOLLY
Other - Middle Name:MILLER
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:292 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1236
Mailing Address - Country:US
Mailing Address - Phone:978-448-5241
Mailing Address - Fax:
Practice Address - Street 1:292 MAIN ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1236
Practice Address - Country:US
Practice Address - Phone:978-448-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858713122300000X
IL018001880122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist