Provider Demographics
NPI:1700027042
Name:KENNETH J MOLNAR DDS INC
Entity Type:Organization
Organization Name:KENNETH J MOLNAR DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOLNAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-529-9494
Mailing Address - Street 1:2191 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1226
Mailing Address - Country:US
Mailing Address - Phone:419-529-9494
Mailing Address - Fax:419-529-9391
Practice Address - Street 1:2191 PARK AVE W
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1226
Practice Address - Country:US
Practice Address - Phone:419-529-9494
Practice Address - Fax:419-529-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000138778OtherANTHEM BC/BS
OH0701486Medicaid
OH271547277005OtherMEDICAL MUTUAL OF OHIO
OH744917OtherUNITED CONCORDIA
OHT80642Medicare UPIN
OH744917OtherUNITED CONCORDIA