Provider Demographics
NPI:1730490996
Name:MOLAR ENTERPRISE, INC.
Entity Type:Organization
Organization Name:MOLAR ENTERPRISE, INC.
Other - Org Name:TIMBERCREST DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-895-4274
Mailing Address - Street 1:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:DELTA JUNCTION
Mailing Address - State:AK
Mailing Address - Zip Code:99737-0985
Mailing Address - Country:US
Mailing Address - Phone:907-895-4274
Mailing Address - Fax:907-895-4276
Practice Address - Street 1:2270 NISTLER RD
Practice Address - Street 2:
Practice Address - City:DELTA JUNCTION
Practice Address - State:AK
Practice Address - Zip Code:99737-0985
Practice Address - Country:US
Practice Address - Phone:907-895-4274
Practice Address - Fax:907-895-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDDG033Medicaid
AKDD08701Medicaid