Provider Demographics
NPI:1275636862
Name:MOLL, RICHARD STIEG (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:STIEG
Last Name:MOLL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2406
Mailing Address - Country:US
Mailing Address - Phone:207-729-3515
Mailing Address - Fax:207-729-0952
Practice Address - Street 1:18 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2406
Practice Address - Country:US
Practice Address - Phone:207-729-3515
Practice Address - Fax:207-729-0952
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
783886OtherUNITED CONCORDIA