Provider Demographics
NPI:1083715403
Name:MOLINA, SHIRLEY K (DMD)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:K
Last Name:MOLINA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2125
Mailing Address - Country:US
Mailing Address - Phone:516-625-3806
Mailing Address - Fax:516-625-6845
Practice Address - Street 1:216 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2125
Practice Address - Country:US
Practice Address - Phone:516-625-3806
Practice Address - Fax:516-625-6845
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051583-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry