Provider Demographics
NPI:1184311235
Name:MOLINA ROJAS, GIOVANNI
Entity type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:
Last Name:MOLINA ROJAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 ARTISAN WAY APT 439
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-1249
Mailing Address - Country:US
Mailing Address - Phone:857-352-6055
Mailing Address - Fax:
Practice Address - Street 1:TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Practice Address - Street 2:1 KNEELAND ST
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADF119191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice