Provider Demographics
NPI:1295813665
Name:MOLEN, CHAD KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:KENNETH
Last Name:MOLEN
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 1:12226 S 1000 E
Mailing Address - Street 2:#7
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-8205
Mailing Address - Country:US
Mailing Address - Phone:801-495-3636
Mailing Address - Fax:
Practice Address - Street 1:12226 S 1000 E
Practice Address - Street 2:#7
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-8205
Practice Address - Country:US
Practice Address - Phone:801-495-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT338752-99211223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics