Provider Demographics
NPI:1790752350
Name:MOLNAR, KENNETH J (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:J
Last Name:MOLNAR
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 1:2191 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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300176111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH744917OtherUNITED CONCORDIA
OH0701486Medicaid
OH000000138778OtherANTHEM BC/BS
OH0701486Medicaid
OHT80642Medicare UPIN