Provider Demographics
NPI:1568982783
Name:KOVALESKY, MOLLY BETH (DDS)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:BETH
Last Name:KOVALESKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:BETH
Other - Last Name:WESTBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:88 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-798-9966
Mailing Address - Fax:
Practice Address - Street 1:88 BROAD STREET
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801
Practice Address - Country:US
Practice Address - Phone:518-798-9966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000310122300000X
NY06505511223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist