Provider Demographics
NPI:1689676082
Name:MOLEN, DAVID GLENN (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GLENN
Last Name:MOLEN
Suffix:
Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:16202 64TH ST E
Mailing Address - Street 2:#105
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-3028
Mailing Address - Country:US
Mailing Address - Phone:253-470-5020
Mailing Address - Fax:253-470-5069
Practice Address - Street 1:16202 64TH ST E
Practice Address - Street 2:#105
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-3028
Practice Address - Country:US
Practice Address - Phone:253-470-5020
Practice Address - Fax:253-470-5069
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WADE 000089831223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN93399Medicare UPIN