Provider Demographics
NPI:1114112349
Name:VERHELST, MOLLY THERESE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:THERESE
Last Name:VERHELST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:THERESE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1789 WOODLANE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-3910
Mailing Address - Country:US
Mailing Address - Phone:651-738-1284
Mailing Address - Fax:
Practice Address - Street 1:1789 WOODLANE DR
Practice Address - Street 2:SUITE D
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-3910
Practice Address - Country:US
Practice Address - Phone:651-738-1284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH7029124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist