Provider Demographics
NPI:1699820134
Name:MOLINA, MAYLING I (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAYLING
Middle Name:I
Last Name:MOLINA
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 1:12297 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-1725
Mailing Address - Country:US
Mailing Address - Phone:954-430-0308
Mailing Address - Fax:954-438-5774
Practice Address - Street 1:12297 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1725
Practice Address - Country:US
Practice Address - Phone:954-430-0308
Practice Address - Fax:954-438-5774
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16243122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist