Provider Demographics
NPI:1801026273
Name:MOLINA, TITO (DDS)
Entity Type:Individual
Prefix:DR
First Name:TITO
Middle Name:
Last Name:MOLINA
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 1:23226 WILLOW CANYON DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-3526
Mailing Address - Country:US
Mailing Address - Phone:310-213-9414
Mailing Address - Fax:
Practice Address - Street 1:23226 WILLOW CANYON DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3526
Practice Address - Country:US
Practice Address - Phone:310-213-9414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584761223G0001X
TX255161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice