Provider Demographics
NPI:1750509907
Name:MOLANDER, FREDERICK R JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:R
Last Name:MOLANDER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2135
Mailing Address - Country:US
Mailing Address - Phone:207-775-1401
Mailing Address - Fax:
Practice Address - Street 1:1250 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2135
Practice Address - Country:US
Practice Address - Phone:207-775-1401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME24231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME114030000Medicare ID - Type UnspecifiedMAINE CARE