Provider Demographics
NPI:1134279987
Name:MCCARTY, MOLLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W TOWN PL STE 106
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3662
Mailing Address - Country:US
Mailing Address - Phone:904-940-7994
Mailing Address - Fax:
Practice Address - Street 1:425 W TOWN PL STE 106
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3662
Practice Address - Country:US
Practice Address - Phone:904-940-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN165731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics