Provider Demographics
NPI:1891014239
Name:GROOVY MOLAR, P.L.L.C.
Entity Type:Organization
Organization Name:GROOVY MOLAR, P.L.L.C.
Other - Org Name:GROOVY MOLAR PEDIATRIC DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:C
Authorized Official - Last Name:SINGLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-810-1378
Mailing Address - Street 1:3410 FAR WEST BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3194
Mailing Address - Country:US
Mailing Address - Phone:512-810-1378
Mailing Address - Fax:
Practice Address - Street 1:3410 FAR WEST BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3194
Practice Address - Country:US
Practice Address - Phone:512-810-1378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211281223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174254602Medicaid
TX170979201Medicaid