Provider Demographics
NPI:1710395421
Name:MOLINARO, SERGIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:MOLINARO
Suffix:
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 1:9703 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2523
Mailing Address - Country:US
Mailing Address - Phone:718-845-4242
Mailing Address - Fax:718-835-1616
Practice Address - Street 1:9703 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2523
Practice Address - Country:US
Practice Address - Phone:718-845-4242
Practice Address - Fax:718-835-1616
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist