Provider Demographics
NPI:1619369675
Name:BUCK MOLINA LLC
Entity Type:Organization
Organization Name:BUCK MOLINA LLC
Other - Org Name:BUCK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-522-7870
Mailing Address - Street 1:4245 N CENTRAL EXPY
Mailing Address - Street 2:#400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4581
Mailing Address - Country:US
Mailing Address - Phone:214-522-7870
Mailing Address - Fax:
Practice Address - Street 1:4245 N CENTRAL EXPY
Practice Address - Street 2:#400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4581
Practice Address - Country:US
Practice Address - Phone:214-522-7870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-28
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty