Provider Demographics
NPI:1659787752
Name:STANFORD, MOLLY BORDELON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:BORDELON
Last Name:STANFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 E SILVER SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470
Mailing Address - Country:US
Mailing Address - Phone:352-229-8583
Mailing Address - Fax:352-263-6017
Practice Address - Street 1:4910 E SILVER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470
Practice Address - Country:US
Practice Address - Phone:352-229-8583
Practice Address - Fax:352-263-6017
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN207691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice