Provider Demographics
NPI:1821209990
Name:MOLLOY, JEFF (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:MOLLOY
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 1:1013 LOCKWOOD BLVD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6001
Mailing Address - Country:US
Mailing Address - Phone:407-278-0934
Mailing Address - Fax:
Practice Address - Street 1:1013 LOCKWOOD BLVD
Practice Address - Street 2:SUITE #7
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6001
Practice Address - Country:US
Practice Address - Phone:407-278-0934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21435122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist