Provider Demographics
NPI:1518336510
Name:MOLLNER, NATHAN JOEL (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JOEL
Last Name:MOLLNER
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 1:2728 W 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-4844
Mailing Address - Country:US
Mailing Address - Phone:719-210-5917
Mailing Address - Fax:
Practice Address - Street 1:975 N LINCOLN ST
Practice Address - Street 2:UNIT 203
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-2725
Practice Address - Country:US
Practice Address - Phone:303-578-6684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-20
Last Update Date:2015-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist