Provider Demographics
NPI:1093326308
Name:MOLAR BEAR PEDIATRIC DENTISTRY LLC
Entity Type:Organization
Organization Name:MOLAR BEAR PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROSENVALL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-592-7595
Mailing Address - Street 1:609 S KNIK GOOSE BAY RD STE D
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-8079
Mailing Address - Country:US
Mailing Address - Phone:907-376-6527
Mailing Address - Fax:
Practice Address - Street 1:609 S KNIK GOOSE BAY RD STE D
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8079
Practice Address - Country:US
Practice Address - Phone:907-376-6527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty