Provider Demographics
NPI:1629494372
Name:MOOLENAAR, LUCIEN ALANZO II (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUCIEN
Middle Name:ALANZO
Last Name:MOOLENAAR
Suffix:II
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:PO BOX 302275
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE AMALIE
Mailing Address - State:VI
Mailing Address - Zip Code:00803-2275
Mailing Address - Country:US
Mailing Address - Phone:340-228-8800
Mailing Address - Fax:
Practice Address - Street 1:1403 4TH STREET, SUGAR ESTATE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE AMALIE
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-228-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice