Provider Demographics
NPI:1962609420
Name:MOLZ, STEPHEN CHARLES (DDS,MBA)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:CHARLES
Last Name:MOLZ
Suffix:
Gender:M
Credentials:DDS,MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1308
Mailing Address - Country:US
Mailing Address - Phone:410-987-1418
Mailing Address - Fax:410-923-1145
Practice Address - Street 1:747 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1308
Practice Address - Country:US
Practice Address - Phone:410-987-1418
Practice Address - Fax:410-923-1145
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD78981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7898OtherLICENSE NUMBER