Provider Demographics
NPI:1932486693
Name:MOLAR MAGIC, LLC-COOOLIDGE
Entity Type:Organization
Organization Name:MOLAR MAGIC, LLC-COOOLIDGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THIEN
Authorized Official - Middle Name:CHI
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-723-0077
Mailing Address - Street 1:1501 N ARIZONA BLVD
Mailing Address - Street 2:
Mailing Address - City:COOLIDGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85128-3215
Mailing Address - Country:US
Mailing Address - Phone:520-123-0077
Mailing Address - Fax:480-393-0926
Practice Address - Street 1:1501 N ARIZONA BLVD
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85128-3215
Practice Address - Country:US
Practice Address - Phone:520-123-0077
Practice Address - Fax:480-393-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty