Provider Demographics
NPI:1619162054
Name:MOLLOY, ROBERT BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRIAN
Last Name:MOLLOY
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 1:9801 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6925
Mailing Address - Country:US
Mailing Address - Phone:405-692-1222
Mailing Address - Fax:405-703-0930
Practice Address - Street 1:9801 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6925
Practice Address - Country:US
Practice Address - Phone:405-692-1222
Practice Address - Fax:405-703-0930
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100126100BOtherOKLAHOMA HEALTHCARE AUTHO