Provider Demographics
NPI:1073103032
Name:J E MOLINA DDS INC.
Entity Type:Organization
Organization Name:J E MOLINA DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-432-3456
Mailing Address - Street 1:1406 E ALLUVIAL AVE # 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2606
Mailing Address - Country:US
Mailing Address - Phone:559-432-3456
Mailing Address - Fax:559-369-6104
Practice Address - Street 1:1406 E ALLUVIAL AVE # 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2606
Practice Address - Country:US
Practice Address - Phone:559-432-3456
Practice Address - Fax:559-369-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty