Provider Demographics
NPI:1730107707
Name:GUILLERMO J. MOLINA, DDS & ASSOCIATES, LLC
Entity Type:Organization
Organization Name:GUILLERMO J. MOLINA, DDS & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-670-7774
Mailing Address - Street 1:1200 E RIDGEWOOD AVE
Mailing Address - Street 2:EAST WING, FIRST FLOOR
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3957
Mailing Address - Country:US
Mailing Address - Phone:201-670-7774
Mailing Address - Fax:
Practice Address - Street 1:1200 E RIDGEWOOD AVE
Practice Address - Street 2:EAST WING, FIRST FLOOR
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3957
Practice Address - Country:US
Practice Address - Phone:201-670-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI018923001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty