Provider Demographics
NPI:1578956967
Name:ARNULFO MOLINA PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:ARNULFO MOLINA PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ARNULFO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-640-6413
Mailing Address - Street 1:10750 GLENOAKS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-7276
Mailing Address - Country:US
Mailing Address - Phone:818-686-1400
Mailing Address - Fax:818-686-1411
Practice Address - Street 1:10750 GLENOAKS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-7276
Practice Address - Country:US
Practice Address - Phone:818-686-1400
Practice Address - Fax:818-686-1411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265676761OtherDENTICAL