Provider Demographics
NPI:1598496168
Name:BURNETT, MOLLY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:ANN
Last Name:BURNETT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LENOX ST STE 113
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-4278
Mailing Address - Country:US
Mailing Address - Phone:781-769-4473
Mailing Address - Fax:
Practice Address - Street 1:125 SAMOSET ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4801
Practice Address - Country:US
Practice Address - Phone:508-746-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18594301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice