Provider Demographics
NPI:1942557103
Name:MOLLOV, NIKOLAY DIMITROV (DDS)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAY
Middle Name:DIMITROV
Last Name:MOLLOV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 S VAN DORN ST
Mailing Address - Street 2:APT. V604
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4254
Mailing Address - Country:US
Mailing Address - Phone:703-862-5959
Mailing Address - Fax:
Practice Address - Street 1:13975 CONNECTICUT AVE
Practice Address - Street 2:SUITE 200-201
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2921
Practice Address - Country:US
Practice Address - Phone:301-460-1212
Practice Address - Fax:301-603-0861
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD150821223X0400X
VA04014135311223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics