Provider Demographics
NPI:1821788092
Name:MOLINA-AGUILAR, DENNIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:MOLINA-AGUILAR
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 1:211 PECAN ST
Mailing Address - Street 2:
Mailing Address - City:DARDANELLE
Mailing Address - State:AR
Mailing Address - Zip Code:72834-4040
Mailing Address - Country:US
Mailing Address - Phone:479-567-4648
Mailing Address - Fax:
Practice Address - Street 1:2533 STATE HIGHWAY 22 W
Practice Address - Street 2:
Practice Address - City:DARDANELLE
Practice Address - State:AR
Practice Address - Zip Code:72834-8831
Practice Address - Country:US
Practice Address - Phone:479-229-3891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR46551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice