Provider Demographics
NPI:1053469650
Name:MOLINA, LUIS GUILLERMO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:GUILLERMO
Last Name:MOLINA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 BERGENLINE AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-7900
Mailing Address - Country:US
Mailing Address - Phone:201-865-2788
Mailing Address - Fax:201-865-0799
Practice Address - Street 1:3600 BERGENLINE AVE
Practice Address - Street 2:2ND FL
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-7900
Practice Address - Country:US
Practice Address - Phone:201-865-2788
Practice Address - Fax:201-865-0799
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020190001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice