Provider Demographics
NPI:1912231549
Name:MOLINA, ROSARIO G (DMD (DENTIST))
Entity type:Individual
Prefix:DR
First Name:ROSARIO
Middle Name:G
Last Name:MOLINA
Suffix:
Gender:F
Credentials:DMD (DENTIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4835 E 4TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013
Mailing Address - Country:US
Mailing Address - Phone:305-685-5133
Mailing Address - Fax:305-685-8076
Practice Address - Street 1:4835 E 4TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013
Practice Address - Country:US
Practice Address - Phone:305-685-5133
Practice Address - Fax:305-685-8076
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist