Provider Demographics
NPI:1568982783
Name:KOVALESKY, MOLLY BETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:BETH
Last Name:KOVALESKY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:BETH
Other - Last Name:WESTBROOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:713 PIERCE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1302
Mailing Address - Country:US
Mailing Address - Phone:518-373-1181
Mailing Address - Fax:518-373-0130
Practice Address - Street 1:713 PIERCE RD
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-373-1181
Practice Address - Fax:518-373-0130
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0442000310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist